Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers : PRESSURE (pressure relieving support surfaces) trial

Objective To compare whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers, healing of existing pressure ulcers, and patient acceptability. Design Pragmatic, open, multicentre, randomised controlled trial. Setting 11 hospitals in six NHS trusts. Participants 1972 people admitted to hospital as acute or elective patients. Interventions Participants were randomised to an alternating pressure mattress (n = 982) of- an alternating pressure overlay (n = 990). Main outcome measures The proportion of participants developing a new pressure ulcer of grade 2 or worse; time to development of new pressure ulcers; proportions of participants developing a new ulcer within 30 days; healing of existing pressure ulcers; and patient acceptability Results Intention to treat analysis found no difference in the proportions of participants developing a new pressure ulcer of grade 2 or worse (10.7% overlay patients, 10.3% mattress patients; difference 0.4%, 95% confidence interval - 23% to 3.1%, P = 0.75). More overlay patients requested change owing to dissatisfaction (23.3%) than mattress patients (18.9%, P = 0.02). Conclusion No difference was found between alternating pressure mattresses and alternating pressure overlays in the proportion of people who develop a pressure ulcer

Pressure relieving support surfaces (PRESSURE) trial : cost effectiveness analysis

Objective To assess tire cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital. Design Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial. Setting 11 hospitals in six UK NHS trusts. Participants Intention to treat population comprising 1971 participants. Main outcome measures Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital. Results Alternating pressure mattresses were associated with lower overall costs (283.6 pound per patient on average, 95% confidence interval -377.59 pound to. 976.79) pound mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average, - 24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost effectiveness acceptability curve indicated that on average alternating pressure mattresses compared with alternating pressure overlays were associated with air 80% probability of being cost saving. Conclusion Alternating pressure mattresses for the prevention of pressure ulcers are more likely to be cost effective and are more acceptable to patients than alternating pressure overlays

Confirming the Primarily Smooth Structure of the Vega Debris Disk at Millimeter Wavelengths

Clumpy structure in the debris disk around Vega has been previously reported at millimeter wavelengths and attributed to concentrations of dust grains trapped in resonances with an unseen planet. However, recent imaging at similar wavelengths with higher sensitivity has disputed the observed structure. We present three new millimeter wavelength observations that help to resolve the puzzling and contradictory observations. We have observed the Vega system with the Submillimeter Array (SMA) at a wavelength of 880 μm and an angular resolution of 5"; with the Combined Array for Research in Millimeter-wave Astronomy (CARMA) at a wavelength of 1.3 mm and an angular resolution of 5"; and with the Green Bank Telescope (GBT) at a wavelength of 3.3 mm and angular resolution of 10". Despite high sensitivity and short baselines, we do not detect the Vega debris disk in either of the interferometric data sets (SMA and CARMA), which should be sensitive at high significance to clumpy structure based on previously reported observations. We obtain a marginal (3σ) detection of disk emission in the GBT data; the spatial distribution of the emission is not well constrained.We analyze the observations in the context of several different models, demonstrating that the observations are consistent with a smooth, broad, axisymmetric disk with inner radius 20–100 AU and width ≾50 AU. The interferometric data require that at least half of the 860 μm emission detected by previous single-dish observations with the James Clerk Maxwell Telescope be distributed axisymmetrically, ruling out strong contributions from flux concentrations on spatial scales of ≾100 AU. These observations support recent results from the Plateau de Bure Interferometer indicating that previous detections of clumpy structure in the Vega debris disk were spurious

Quantifying solar superactive regions with vector magnetic field observations

The vector magnetic field characteristics of superactive regions (SARs) hold the key for understanding why SARs are extremely active and provide the guidance in space weather prediction. We aim to quantify the characteristics of SARs using the vector magnetograms taken by the Solar Magnetic Field Telescope at Huairou Solar Observatory Station. The vector magnetic field characteristics of 14 SARs in solar cycles 22 and 23 were analyzed using the following four parameters: 1) the magnetic flux imbalance between opposite polarities, 2) the total photospheric free magnetic energy, 3) the length of the magnetic neutral line with its steep horizontal magnetic gradient, and 4) the area with strong magnetic shear. Furthermore, we selected another eight large and inactive active regions (ARs), which are called fallow ARs (FARs), to compare them with the SARs. We found that most of the SARs have a net magnetic flux higher than 7.0\times10^21 Mx, a total photospheric free magnetic energy higher than 1.0\times10^24 erg/cm, a magnetic neutral line with a steep horizontal magnetic gradient (\geq 300 G/Mm) longer than 30 Mm, and an area with strong magnetic shear (shear angle \geq 80\degree) greater than 100 Mm^2. In contrast, the values of these parameters for the FARs are mostly very low. The Pearson \c{hi}2 test was used to examine the significance of the difference between the SARs and FARs, and the results indicate that these two types of ARs can be fairly distinguished by each of these parameters. The significance levels are 99.55%, 99.98%, 99.98%, and 99.96%, respectively. However, no single parameter can distinguish them perfectly. Therefore we propose a composite index based on these parameters, and find that the distinction between the two types of ARs is also significant with a significance level of 99.96%. These results are useful for a better physical understanding of the SAR and FARComment: 9 pages, 3 figures, 2 table

Comparison of statistical and dynamical downscaling methods for seasonal-scale winter precipitation predictions over north India

The main aim of the present study is to analyse the capabilities of two downscaling approaches (statistical and dynamical) in predicting wintertime seasonal precipitation over north India. For this purpose, a canonical correlation analysis (CCA) based statistical downscaling approach and dynamical downscaling approach (at 30 km) with an optimized configuration of the regional climate model (RegCM) nested in coarse resolution global spectral model have been used for a period of 28 years (1982–2009). For CCA, nine predictors (precipitation, zonal and meridional winds at 850 and 200 hPa, temperature at 200 hPa and sea surface temperatures) over three different domains were selected. The predictors were chosen based on the statistically significant teleconnection maps and physically based relationships between precipitation over the study region and meteorological variables. The validation revealed that both the downscaling approaches provided improved precipitation forecasts compared to the global model. Reasons for improved prediction by downscaling techniques have been examined. The improvement mainly comes due to better representation of orography, westerly moisture transport and vertical pressure velocity in the regional climate model. Furthermore, two bias correction methods namely quantile mapping (QM) and mean bias-remove (MBR) have been applied on downscaled RegCM, statistically downscaled CCA as well as the global model products. It was found that when the QM-based bias correction is applied on dynamically downscaled RegCM products, it has better skill in predicting wintertime precipitation over the study region compared to the CCA-based statistical downscaling. Overall, the results indicate that the QM-based bias-corrected downscaled RegCM model is a useful tool for wintertime seasonal-scale precipitation prediction over north India.Peer reviewedFinal Accepted Versio

Lake Michigan’s suitability for bigheaded carp: The importance of diet flexibility and subsurface habitat

As bighead (Hypophthalmichthys nobilis) and silver carp (Hypophthalmichthys molitrix)—collectively bigheaded carp (BHC)—arrive at Lake Michigan’s doorstep, questions remain as to whether there is sufficient food to support these invasive filter‐feeding fishes in the upper Laurentian Great Lakes. Previous studies suggest that suitable BHC habitat is limited to a few productive, nearshore areas. However, those studies did not consider the influence of BHC’s diet plasticity or the presence of spatially‐discrete subsurface prey resources. This study aimed to characterise Lake Michigan’s suitability for BHC and evaluate the importance of these considerations in habitat suitability assessments.We used simulated outputs of prey biomass (phytoplankton, zooplankton, and detritus) and water temperature from a three‐dimensional biophysical model of Lake Michigan to evaluate growth rate potential (GRP, quantitative index of habitat suitability) of adult BHC throughout the entire volume of the lake. Our GRP model applied a foraging model and a bioenergetics model to translate prey concentrations and water temperatures into habitat quality indexed by individual fish growth rate. We defined suitable habitat as habitats that can support GRP ≥ 0 g g−1 day−1. We developed six feeding scenarios to evaluate the impact of diet flexibility and subsurface prey resources on suitable habitat quantity. Scenarios were defined by the number of prey types the fish could consume and the depths at which they could feed (surface or whole water column).Consistent with previous studies, we found that habitats with the highest quality were concentrated near river mouths and in eutrophic areas of Green Bay. However, in contrast to previous studies, we found suitable offshore habitat for bighead carp owing to our added considerations of diet plasticity and subsurface prey resources. For silver carp, these considerations extended suitable habitat within Green Bay and in some tributary‐influenced nearshore areas, but offshore areas remained predominantly unsuitable in all feeding scenarios. Differences in simulated habitat suitability between these two species probably reflect differences in energy density and mass of the specific fishes we used in our model. However, reports of these two species in environments where they coexist indicate that bighead carp grow at faster rates than silver carp, as our model simulated.Our vertical analysis at Muskegon, MI, U.S.A. indicates that subsurface temperature and prey biomass are not only sufficient to support bighead carp growth but provide maximum habitat quality during late summer stratification.Overall, our study demonstrates that BHC are capable of surviving and growing in much larger areas of Lake Michigan than predicted by previous studies, and thus suggests that the risk of establishment is not sufficiently reduced by low plankton concentrations. Maps generated by our model identified the potential for cross‐lake migration corridors that may facilitate and accelerate lake‐wide movements. We believe these maps could be used to prioritise surveillance protocols by identifying areas to which BHC might spread upon entering the lake. More broadly, this research demonstrates how the physiology and trophic ecology of BHC contributes to their high invasive capacity and can permit their survival in novel environments.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151968/1/fwb13382_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151968/2/fwb13382.pd

Warm dusty discs: Exploring the A star 24um debris population

(Abridged) Studies of debris discs have shown that most systems are analogous to the EKB. In this study we aim to determine how many IRAS 25um excesses towards A stars are real, and investigate where the dust lies. We observe with TIMMI2, VISIR, Michelle and TReCS a sample of A and B-type main sequence stars reported as having mid-IR excess. We constrain the location of the debris through combined modelling of the emission spectrum and a modelling technique designed to constrain the radial extent of emission in mid-IR imaging. We independently confirm the presence of warm dust around 3 of the candidates: HD3003, HD80950 and eta Tel. For the binary HD3003 a stability analysis indicates the dust is either circumstellar and lying at ~4 AU with the binary orbiting at >14AU, or the dust lies in an unstable location; there is some evidence for temporal evolution of its excess emission on a ~20 year timescale. For 7 of the targets we present quantitative limits on the location of dust around the star. We demonstrate that the disc around HD71155 must have spatially distinct components at 2 and 60AU. We model the limits of current instrumentation and show that most of the known A star debris discs which could be readily resolved at 18um on 8m instruments have been resolved. Limits from unresolved imaging can help distinguish between competing models of the disc emission, but resolved imaging is key to the determination of the disc location. Modelling of the detection limits for extended emission can be useful for targeting future observational campaigns. MIRI on the JWST will be able to resolve most of the known A star debris disc population. METIS on the E-ELT will provide the opportunity to explore the hot disc population more thoroughly by detecting extended emission where calibration accuracy limits disc detection through photometry, reaching levels below 1 zodi for stars at <10pc.Comment: Accepted for publication in Astronomy and Astrophysic

The International Deep Planet Survey I. The frequency of wide-orbit massive planets around A-stars

Breakthrough direct detections of planetary companions orbiting A-type stars confirm the existence of massive planets at relatively large separations, but dedicated surveys are required to estimate the frequency of similar planetary systems. To measure the first estimation of the giant exoplanetary systems frequency at large orbital separation around A-stars, we have conducted a deep-imaging survey of young (8-400 Myr), nearby (19-84 pc) A- and F-stars to search for substellar companions in the 10-300 AU range. The sample of 42 stars combines all A-stars observed in previous AO planet search surveys reported in the literature with new AO observations from VLT/NaCo and Gemini/NIRI. It represents an initial subset of the International Deep Planet Survey (IDPS) sample of stars covering M- to B-stars. The data were obtained with diffraction-limited observations in H- and Ks-band combined with angular differential imaging to suppress the speckle noise of the central stars, resulting in typical 5-sigma detection limits in magnitude difference of 12 mag at 1", 14 mag at 2" and 16 mag at 5" which is sufficient to detect massive planets. A detailed statistical analysis of the survey results is performed using Monte Carlo simulations. Considering the planet detections, we estimate the fraction of A-stars having at least one massive planet (3-14 MJup) in the range 5-320 AU to be inside 5.9-18.8% at 68% confidence, assuming a flat distribution for the mass of the planets. By comparison, the brown dwarf (15-75 MJup) frequency for the sample is 2.0-8.9% at 68% confidence in the range 5-320 AU. Assuming power law distributions for the mass and semimajor axis of the planet population, the AO data are consistent with a declining number of massive planets with increasing orbital radius which is distinct from the rising slope inferred from radial velocity (RV) surveys around evolved A-stars.Comment: 20 pages, 10 figures, 7 tables. Accepted for publication in A&

Vitamin D deficiency in traumatic brain injury and its relationship with severity of injury and quality of life: a prospective, observational study

This single-centre prospective observational study aims to describe the prevalence of vitamin D deficiency (VDD) in the traumatic brain injury (TBI) population and identify any relationship between vitamin D and severity of head injury or quality of life. 124 TBI patients had serum vitamin D (25-OHD) levels measured at the local post-TBI endocrine screening clinic over 20 months. Quality of Life after Brain Injury (QOLIBRI) questionnaires were completed by the patient concurrently. A multivariate regressional analysis was performed, controlling for age, season, ethnicity, time since injury, TBI severity and gender. 34% (n=42) of the cohort were vitamin D deficient (25-OHD <25nmol/L) with a further 23% (n=29) having insufficient levels (25-OHD 25-50nmol/L). Vitamin D was significantly lower in severe TBI compared to mild TBI (n=95, p=0.03, CI 95% -23.60 to -1.21, mean effect size 12.40 nmol/L). There was a trend for self-reported quality of life to be better in patients with optimum vitamin D levels compared to patients with deficient vitamin D levels, controlling for severity of injury (n=81, p=0.05, CI 95% -0.07 to 21.27). This is the first study to identify a significant relationship between vitamin D levels and severity of head injury. Clinicians should actively screen for and treat VDD in head injured patients to reduce the risk of further morbidity such as osteomalacia and cardiovascular disease. Future research should establish the natural history of vitamin D levels following TBI to identify at which stage VDD develops and whether vitamin D replacement could have a beneficial effect on recovery and quality of life