Smoking and ethnic group, not epidural use, determine breast feeding outcome

No abstract available

Where do hands go? An audit of sequential hand-touch events on a hospital ward

Reservoirs of pathogens could establish themselves at forgotten sites on a ward, posing a continued risk for transmission to patients via unwashed hands. To track potential spread of organisms between surfaces and patients, and to gaina greater understanding into transmission pathways of pathogens during patient care. Hand-touch activities were audited covertly for 40 30 min sessions during summer and winter, and included hand hygiene on entry; contact with near-patient sites; patient contact; contact with clinical equipment; hand hygiene on exit; and contact with sites outside the room. There were 104 entries overall: 77 clinical staff (59 nurses; 18 doctors), 21 domestic staff, one pharmacist and five relatives. Hand-hygiene compliance among clinical staff before and after entry was 25% (38/154), with higher compliance during 20 summer periods [47%; 95% confidence interval (CI): 35.6e58.8] than during 20 winter periods (7%; 95% CI: 3.2e14.4; P < 0.0001). More than half of the staff (58%; 45/77) touched the patient. Staff were more likely to clean their hands prior to contact with a patient [odds ratio (OR): 3.44; 95% CI: 0.94e16.0); P ¼ 0.059] and sites beside the patient (OR: 6.76; 95% CI: 1.40e65.77; P ¼ 0.0067). Nearly half (48%; 37/77) handled patient notes and 25% touched the bed. Most frequently handled equipment inside the room were intravenous drip (30%) and blood pressure stand (13%), and computer (26%), notes trolley (23%) and telephone (21%) outside the room. Hand-hygiene compliance remains poor during covert observation; understanding the most frequent interactions between hands and surfaces could target sites for cleaning

Transversus abdominis plane blocks; a national survey of techniques used by UK obstetric anaesthetists

No abstract available

The Cost of Stability in Coalitional Games

A key question in cooperative game theory is that of coalitional stability, usually captured by the notion of the \emph{core}--the set of outcomes such that no subgroup of players has an incentive to deviate. However, some coalitional games have empty cores, and any outcome in such a game is unstable. In this paper, we investigate the possibility of stabilizing a coalitional game by using external payments. We consider a scenario where an external party, which is interested in having the players work together, offers a supplemental payment to the grand coalition (or, more generally, a particular coalition structure). This payment is conditional on players not deviating from their coalition(s). The sum of this payment plus the actual gains of the coalition(s) may then be divided among the agents so as to promote stability. We define the \emph{cost of stability (CoS)} as the minimal external payment that stabilizes the game. We provide general bounds on the cost of stability in several classes of games, and explore its algorithmic properties. To develop a better intuition for the concepts we introduce, we provide a detailed algorithmic study of the cost of stability in weighted voting games, a simple but expressive class of games which can model decision-making in political bodies, and cooperation in multiagent settings. Finally, we extend our model and results to games with coalition structures.Comment: 20 pages; will be presented at SAGT'0

Exploring experiential differences in everyday activities – A focused ethnographic study in the homes of people living with memory-led Alzheimer's disease and posterior cortical atrophy

Background Supporting ageing in place, quality of life and activity engagement are public health priorities for people living with dementia, but little is known about the needs and experiences of community-dwelling people with rarer forms of dementia with lesser known symptoms. Posterior cortical atrophy (PCA) is a rare form of dementia usually caused by Alzheimer's disease but which is characterised by diminished visual processing (rather than a dominant memory problem), which poses challenges for maintaining independence and accessing appropriate support. Methods This study used a comparative qualitative design and focussed ethnographic methods to explore experiential differences in activity engagement for 10 people with the most common, memory-led presentation of Alzheimer's disease and 10 people with posterior cortical atrophy within their everyday home environments. Results While the data collection revealed much rich variation in individual and contextual factors, some tentative high-level differences in the experiences of everyday activities could be drawn out, seemingly attributable to the different diagnoses' differing dominant symptoms. These included people with posterior cortical atrophy being less likely to use environmental cues to initiate activities, and more likely to withhold from asking for support because of preserved insight into the impact of this on carers. This lack of initiation of activities could be misinterpreted as apathy. People with posterior cortical atrophy also were discouraged from engaging in activities by disorientation within the home, and difficulties localising, identifying and manipulating objects. People with the more common, memory-led presentation of Alzheimer's disease exhibited more memory-based difficulties with engaging with activities such as forgetting planned activities, where to locate the items required for an activity and the steps involved. Despite these distinct symptom-led challenges, all participants and their family members demonstrated resourcefulness and resilience in making creative adaptations to support continued engagement in everyday activities, supporting the widely reported management strategies of people with dementia of the Alzheimer's type more generally. Conclusions These findings offer helpful insights into some the differing impacts dementia related visual and memory impairments can have on everyday activity engagement, which will be helpful for others navigating these challenges and the health and social care practitioners working with people affected by these conditions. The findings also highlight the vast individual variation in the multitude of individual and contextual factors involved in everyday activity engagement, and suggest important areas for future work utilising methods which are similarly high in ecological validity and accessibility as the home-based focussed ethnographic methods utilised here

The metabolism of small cellular RNA species during productive subgroup C adenovirus infection

AbstractDuring the late phase of subgroup C adenovirus infection, export of cellular mRNA from the nucleus to the cytoplasm isinhibited. In one approach to investigate the mechanism whereby viral late mRNAs are selected for export, we have examined the metabolism of small cellular RNA species transcribed by all three RNA polymerases during the late phase of Ad5 infection. No changes in the quantities of [3H]uridine-labeled 5S rRNA or tRNAs entering the cytoplasm were observed in infected cells. Adenovirus type 5 infection reduced the nuclear and cytoplasmic populations of the newly synthesized, snRNP-associated snRNAs U1, U2, U4, U5, and U6. Transcription of a representative snRNA, U1 RNA, was not inhibited, indicating that the post-transcriptional metabolism of snRNAs was perturbed during the late phase of infection. The increased cytoplasmic concentration of newly synthesized U1 RNA in Ad5- compared to mock-infected cells, and the greater reduction of the snRNP-associated compared to the total U1 RNA population, indicated that snRNP assembly in the cytoplasm was impaired. As adenovirus infection does not perturb export from the nucleus of small cellular mRNAs transcribed by RNA polymerases II and III, viral mRNA must be distinguished for selective export at a nuclear step upstream of translocation to the cytoplasm via nuclear pore complexes

Deriving a preference-based measure for cancer using the EORTC QLQ-C30 : a confirmatory versus exploratory approach

Background: To derive preference-based measures from various condition-specific descriptive health-related quality of life (HRQOL) measures. A general 2-stage method is evolved: 1) an item from each domain of the HRQOL measure is selected to form a health state classification system (HSCS); 2) a sample of health states is valued and an algorithm derived for estimating the utility of all possible health states. The aim of this analysis was to determine whether confirmatory or exploratory factor analysis (CFA, EFA) should be used to derive a cancer-specific utility measure from the EORTC QLQ-C30. Methods: Data were collected with the QLQ-C30v3 from 356 patients receiving palliative radiotherapy for recurrent or metastatic cancer (various primary sites). The dimensional structure of the QLQ-C30 was tested with EFA and CFA, the latter based on a conceptual model (the established domain structure of the QLQ-C30: physical, role, emotional, social and cognitive functioning, plus several symptoms) and clinical considerations (views of both patients and clinicians about issues relevant to HRQOL in cancer). The dimensions determined by each method were then subjected to item response theory, including Rasch analysis. Results: CFA results generally supported the proposed conceptual model, with residual correlations requiring only minor adjustments (namely, introduction of two cross-loadings) to improve model fit (increment χ2(2) = 77.78, p 75% observation at lowest score), 6 exhibited misfit to the Rasch model (fit residual > 2.5), none exhibited disordered item response thresholds, 4 exhibited DIF by gender or cancer site. Upon inspection of the remaining items, three were considered relatively less clinically important than the remaining nine. Conclusions: CFA appears more appropriate than EFA, given the well-established structure of the QLQ-C30 and its clinical relevance. Further, the confirmatory approach produced more interpretable results than the exploratory approach. Other aspects of the general method remain largely the same. The revised method will be applied to a large number of data sets as part of the international and interdisciplinary project to develop a multi-attribute utility instrument for cancer (MAUCa)

Characterisation of the inshore fish assemblages of the Pilbara and Kimberley coasts

All of the objectives of this project have been met by documenting the following: the overall catch of the key commercial, recreational and charter boat fish species; the species composition and relative abundance of the inshore demersal finfish resource from the shoreline outward to a depth of 30 m along the inner continental shelf in north-western Australia; and the nursery areas of the major commercial and recreational fish species in the Pilbara and Kimberley regions

Minimizing energy demand and environmental impact for sustainable NH3 and H2O2 production—A perspective on contributions from thermal, electro-, and photo-catalysis

There is an urgent need to provide adequate and sustainable supplies of water and food to satisfy the demand of an increasing population. Catalysis plays important roles in meeting these needs by facilitating the synthesis of hydrogen peroxide that is used in water decontamination and chemicals production, and ammonia that is used as fertilizer. However, these chemicals are currently produced with processes that are either very energy-intensive or environmentally unfriendly. This article offers the perspectives of the challenges and opportunities in the production of these chemicals, focusing on the roles of catalysis in more sustainable, alternative production methods that minimize energy consumption and environmental impact. While not intended to be a comprehensive review, the article provides a critical review of selected literature relevant to its objectives, discusses areas needed for further research, and potential new directions inspired by new developments in related fields. For each chemical, production by thermal, electro-, and photo-excited processes are discussed. Problems that are common to these approaches and their differences are identified and possible solutions suggested

Basal topographic controls on rapid retreat of Humboldt Glacier, northern Greenland

Discharge from marine-terminating outlet glaciers accounts for up to half the recent mass loss from the Greenland ice sheet, yet the causal factors are not fully understood. Here we assess the factors controlling the behaviour of Humboldt Glacier (HG), allowing us to evaluate the influence of basal topography on outlet glacier response to external forcing since part of HG’s terminus occupies a large overdeepening. HG’s retreat accelerated dramatically after 1999, coinciding with summer atmospheric warming of up to 0.19°C a–1 and sea-ice decline. Retreat was an order of magnitude greater in the northern section of the terminus, underlain by a major basal trough, than in the southern section, where the bedrock is comparatively shallow. Velocity change following retreat was spatially non-uniform, potentially due to a pinning point near HG’s northern lateral margin. Consistent with observations, numerical modelling demonstrates an order-of-magnitude greater sensitivity to sea-ice buttressing and crevasse depth (used as a proxy for atmospheric warming) in the northern section. The trough extends up to 72 km inland, so it is likely to facilitate sustained retreat and ice loss from HG during the 21st century