Fuel poverty, older people and cold weather: An all-island analysis

Executive Summary This report covers a number of different aspects of fuel poverty and older people. 1. An exploration of existing government survey data from Northern Ireland and the Republic of Ireland with a particular focus on older people and conducting additional targeted analyses where required. 2. An original survey in the Republic of Ireland exploring the lived experience of older people in cold weather. 3. A feasibility study of data logging thermometers placed in the homes of older tenants in local authority accommodation. 4. Analysis of excess winter mortality among older people including a consideration of differences between the two jurisdictions. Older people on the island of Ireland, as in many other countries, experience a ‘dual burden’ in terms of fuel poverty. They are more likely to experience fuel poverty and are also particularly vulnerable to health and social harm as a result of this experience. The numbers of older people vulnerable to ill-effects from cold homes will rise as numbers of people aged 80 and over, and those living with chronic illness or disability, increase. There were significant differences observed between expenditure-based, and subjective (EU-SILC) based fuel poverty indicators, for older people, and between Northern Ireland and Republic of Ireland data. This data required careful interpretation. The higher levels of fuel poverty recorded for older people on the island of Ireland appeared to be driven by all aspects of the fuel poverty model - poor housing condition, energy inefficient housing, rising fuel prices and low income. The majority of older people live in their own home and these homes tend to be older properties which are detached or semi-detached. Older people on the island are over-represented among houses which are in poor condition and which lack central heating in both jurisdictions. Lacking central heating was a more common experience for older people in the Republic of Ireland than in Northern Ireland. Data on energy efficiency measures were not comparable North/South but similar patterns were observed. Older people were less likely than the general population to have attic/loft or wall insulation or double glazing. Older people were also vulnerable from an income point of view. This would seem to be a particular issue in Northern Ireland where rates of income poverty are significantly increasing. In both jurisdictions older people were heavily reliant on social transfers to keep them out of poverty. Coupled with this, there is evidence that many older people are not claiming their full entitlements. Oil dependency was a particular issue in Northern Ireland. Very significant increases were observed in the price of heating oil, as well as electricity and gas in recent years. There was little available research evidence on the relationship between the older consumer and heating oil suppliers

Spaceborne CO2 laser communications systems

Projections of the growth of earth-sensing systems for the latter half of the 1980's show a data transmission requirement of 300 Mbps and above. Mission constraints and objectives lead to the conclusion that the most efficient technique to return the data from the sensing satellite to a ground station is through a geosynchronous data relay satellite. Of the two links that are involved (sensing satellite to relay satellite and relay satellite to ground), a laser system is most attractive for the space-to-space link. The development of CO2 laser systems for space-to-space applications is discussed with the completion of a 300 Mpbs data relay receiver and its modification into a transceiver. The technology and state-of-the-art of such systems are described in detail

A retrospective study of cognitive function in doctors and dentists with suspected performance problems: an unsuspected but significant concern.

OBJECTIVE: To examine the performance assessments and cognitive function of practitioners referred to the National Clinical Assessment Service (NCAS). DESIGN: Retrospective observational study. SETTING: Practitioners referred to NCAS for performance assessment due to suspected performance problems. PARTICIPANTS: One hundred and nine practitioners over the age of 45 years referred to NCAS between 1 September 2008 and 30 June 2012. MAIN OUTCOME MEASURES: Reasons for referral of practitioners and their characteristics; details of their assessments including screening for cognition using Addenbrooke's Cognitive Examination Revised (ACE-R); outcome of the process. RESULTS: Reasons for referral included 'clinical difficulties' and 'governance or safety issues'. Eighty-seven practitioners scored above 88 on ACE-R. Twenty-two were found to have an ACE-R score of ≤88. On further assessment, 14 of these 22 practitioners were found to have cognitive impairment. The majority of all practitioners were found to be performing below the expected level of practice for someone at their grade and specialty. Of those scoring ≤88 on the screening, only seven continued in clinical practice. CONCLUSIONS: A high proportion of practitioners scoring poorly on ACE-R were found to have cognitive impairment following detailed neuropsychological testing, the youngest aged 46 years. Many were working in isolation. Nearly all practitioners scoring poorly on ACE-R were international medical graduates; reasons for this are unclear. Performance assessment results showed persisting failings in the practitioners' record keeping and in their assessment of patients. Our findings highlight the need for increased vigilance and training of responsible officers to recognise performance problems and emphasise the importance of comprehensive assessment

Human thrombin for the treatment of gastric and ectopic varices

AIM: To evaluate the efficacy of human thrombin in the treatment of bleeding gastric and ectopic varices. METHODS: Retrospective observational study in a Tertiary Referral Centre. Between January 1999-October 2005, we identified 37 patients who were endoscopically treated with human thrombin injection therapy for bleeding gastric and ectopic varices. Patient details including age, gender and aetiology of liver disease/segmental portal hypertension were documented. The thrombin was obtained from the Scottish National Blood Transfusion Service and prepared to give a solution of 250 IU/mL which was injected via a standard injection needle. All patient case notes were reviewed and the total dose of thrombin given along with the number of endoscopy sessions was recorded. Initial haemostasis rates, rebleeding rates and mortality were catalogued along with the incidence of any immediate complications which could be attributable to the thrombin therapy. The duration of follow up was also listed. The study was conducted according to the United Kingdom research ethics guidelines. RESULTS: Thirty-seven patients were included. 33 patients (89%) had thrombin (250 U/mL) for gastric varices, 2 (5.4%) for duodenal varices, 1 for rectal varices and 1 for gastric and rectal varices. (1) Gastric varices, an average of 15.2 mL of thrombin was used per patient. Re-bleeding occurred in 4 patients (10.8%), managed in 2 by a transjugular intrahepatic portosystemic shunt (TIPSS) (one unsuccessfully who died) and in other 2 by a distal splenorenal shunt; (2) Duodenal varices (or type 2 isolated gastric varices), an average of 12.5 mL was used per patient over 2-3 endoscopy sessions. Re-bleeding occurred in one patient, which was treated by TIPSS; and (3) Rectal varices, an average of 18.3 mL was used per patient over 3 endoscopy sessions. No re-bleeding occurred in this group. CONCLUSION: Human thrombin is a safe, easy to use and effective therapeutic option to control haemorrhage from gastric and ectopic varices

To Trust or Not to Trust? Developing Trusted Digital Spaces through Timely Reliable and Personalized Provenance

Organizations are increasingly dependent on data stored and processed by distributed, heterogeneous services to make critical, high-value decisions. However, these service-oriented computing environments are dynamic in nature and are becoming ever more complex systems of systems. In such evolving and dynamic eco-system infrastructures, knowing how data was derived is of significant importance in determining its validity and reliability. To address this, a number of advocates and theorists postulate that provenance is critical to building trust in data and the services that generated it as it provides evidence for data consumers to judge the integrity of the results. This paper presents a summary of the STRAPP (trusted digital Spaces through Timely Reliable And Personalised Provenance) project, which is designing and engineering mechanisms to achieve a holistic solution to a number of real-world service-based decision-support systems

Secreted frizzled-related protein disrupts PCP in eye lens fiber cells that have polarised primary cilia

AbstractPlanar cell polarity (PCP) signaling polarises cells along tissue axes. Although pathways involved are becoming better understood, outstanding issues include; (i) existence/identity of cues that orchestrate global polarisation in tissues, and (ii) the generality of the link between polarisation of primary cilia and asymmetric localisation of PCP proteins. Mammalian lenses are mainly comprised of epithelial-derived fiber cells. Concentrically arranged fibers are precisely aligned as they elongate along the anterior–posterior axis and orientate towards lens poles where they meet fibers from other segments to form characteristic sutures. We show that lens exhibits PCP, with each fiber cell having an apically situated cilium and in most cases this is polarised towards the anterior pole. Frizzled and other PCP proteins are also asymmetrically localised along the equatorial–anterior axis. Mutations in core PCP genes Van Gogh-like 2 and Celsr1 perturb oriented fiber alignment and suture formation. Suppression of the PCP pathway by overexpressing Sfrp2 shows that whilst local groups of fibers are often similarly oriented, they lack global orientation; consequently when local groups of fibers with different orientations meet they form multiple, small, ectopic suture-like configurations. This indicates that this extracellular inhibitor disrupts a global polarising signal that utilises a PCP-mediated mechanism to coordinate the global alignment and orientation of fibers to lens poles

Art work or money: Conflicts in the construction of a creative identity

The identity projects of novice creative practitioners must take account of the economy of art work. It has been suggested (McRobbie, 2002a) that in the contemporary cultural industries in the UK, a new understanding of the connection between creative work and money has replaced past 'anti-commercial' notions. This claim is investigated through a narrative-discursive analysis of interviews from a longitudinal study with current and recent Art and Design postgraduates. Their ongoing identity projects are shaped by established understandings of creative work and the prospects it offers for earning and employment, and also by more local discursive resources given by personal life contexts. An analysis of two interviews with a single speaker shows how these resources are taken up within her ongoing and distinctive identity project. Both old and new repertoires of art and money are in play in her talk. She must negotiate dilemmas and potentially troubled positionings in order to reconcile a creative identity with relationships and responsibilities towards others. Coherence is only achieved momentarily and is disrupted by new life circumstances. By investigating an identity project at the level of talk, the analysis shows the complexity of the speaker's work to construct and claim a creative identity

CE13015

In the southwest of Ireland and the Celtic Sea (ICES Divisions VIIaS, g & j),herring acoustic surveys have been carried out since 1989. This survey was undertaken in early October. The geographical confines of the annual 21 day survey program have been modified in recent years to include areas to the south of the main winter spawning grounds in an effort to identify the whereabouts of winter spawning fish before the annual inshore spawning migration. Spatial resolution of acoustic transects has been increased over the entire south coast survey area. The acoustic component of the survey has been further complimented since 2004 by detailed hydrographic and marine mammal and seabird surveys.Funder: Marine Institut

Response rates in postal surveys of healthcare professionals between 1996 and 2005: An observational study

<p>Abstract</p> <p>Background</p> <p>Postal surveys are a frequently used method of data collection in health services research. Low response rates increase the potential for bias and threaten study validity. The objectives of this study were to estimate current response rates, to assess whether response rates are falling, to explore factors that might enhance response rates and to examine the potential for non-response bias in surveys mailed to healthcare professionals.</p> <p>Methods</p> <p>A random sample of postal or electronic surveys of healthcare workers (1996-2005) was identified from Medline, Embase or Psycinfo databases or Biomed Central. Outcome measures were survey response rate and non response analysis. Multilevel, multivariable logistic regression examined the relationship between response rate and publication type, healthcare profession, country and number of survey participants, questionnaire length and use of reminders.</p> <p>Results</p> <p>The analysis included 350 studies. Average response rate in doctors was 57.5% (95%CI: 55.2% to 59.8%) and significantly lower than the estimate for the prior 10 year period. Response rates were higher when reminders were sent (adjusted OR 1.3; 95%CI 1.1-1.6) but only half the studies did this. Response rates were also higher in studies with fewer than 1000 participants and in countries other than US, Canada, Australia and New Zealand. They were not significantly affected by publication type or healthcare profession (p > 0.05). Only 17% of studies attempted assessment of possible non-response bias.</p> <p>Conclusion</p> <p>Response rates to postal surveys of healthcare professionals are low and probably declining, almost certainly leading to unknown levels of bias. To improve the informativeness of postal survey findings, researchers should routinely consider the use of reminders and assess potential for non-response bias.</p

Digital methods to enhance the usefulness of patient experience data in services for long-term conditions: the DEPEND mixed-methods study

Background Collecting NHS patient experience data is critical to ensure the delivery of high-quality services. Data are obtained from multiple sources, including service-specific surveys and widely used generic surveys. There are concerns about the timeliness of feedback, that some groups of patients and carers do not give feedback and that free-text feedback may be useful but is difficult to analyse. Objective To understand how to improve the collection and usefulness of patient experience data in services for people with long-term conditions using digital data capture and improved analysis of comments. Design The DEPEND study is a mixed-methods study with four parts: qualitative research to explore the perspectives of patients, carers and staff; use of computer science text-analytics methods to analyse comments; co-design of new tools to improve data collection and usefulness; and implementation and process evaluation to assess use of the tools and any impacts. Setting Services for people with severe mental illness and musculoskeletal conditions at four sites as exemplars to reflect both mental health and physical long-terms conditions: an acute trust (site A), a mental health trust (site B) and two general practices (sites C1 and C2). Participants A total of 100 staff members with diverse roles in patient experience management, clinical practice and information technology; 59 patients and 21 carers participated in the qualitative research components. Interventions The tools comprised a digital survey completed using a tablet device (kiosk) or a pen and paper/online version; guidance and information for patients, carers and staff; text-mining programs; reporting templates; and a process for eliciting and recording verbal feedback in community mental health services. Results We found a lack of understanding and experience of the process of giving feedback. People wanted more meaningful and informal feedback to suit local contexts. Text mining enabled systematic analysis, although challenges remained, and qualitative analysis provided additional insights. All sites managed to collect feedback digitally; however, there was a perceived need for additional resources, and engagement varied. Observation indicated that patients were apprehensive about using kiosks but often would participate with support. The process for collecting and recording verbal feedback in mental health services made sense to participants, but was not successfully adopted, with staff workload and technical problems often highlighted as barriers. Staff thought that new methods were insightful, but observation did not reveal changes in services during the testing period. Conclusions The use of digital methods can produce some improvements in the collection and usefulness of feedback. Context and flexibility are important, and digital methods need to be complemented with alternative methods. Text mining can provide useful analysis for reporting on large data sets within large organisations, but qualitative analysis may be more useful for small data sets and in small organisations. Limitations New practices need time and support to be adopted and this study had limited resources and a limited testing time. Future work Further research is needed to improve text-analysis methods for routine use in services and to evaluate the impact of methods (digital and non-digital) on service improvement in varied contexts and among diverse patients and carers. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 28. See the NIHR Journals Library website for further project information