In adults with multimorbidity, does the provision of social care services have an effect on the use of primary care and secondary care health services?

Objectives: Health and social care is an area of high policy importance in the UK. Integration of health boards with local authority provided social care in Scotland in 2016 is a major structural change in delivery of care. Improvements in service and efficiency are expected and indeed required in an era of declining budgets. Intuitively, health and social care are closely linked, particularly for those with multiple morbidities. However, little is known about the relationship between health and social care services and how usage of one has an impact on the other in terms of outcomes and costs. The study aims to describe the methods that have been used to analyse the relationship between social care, primary care and secondary care services. Findings will inform the analysis of a large linked dataset of health care, social care and benefits data that will investigate the interactions between health and social care, multimorbidity and socioeconomic status. Approach: A Scoping review of literature aiming to identify academic studies that have made an assessment of the relationship between health care and social care. A search of academic databases will be augmented by a search of grey literature aiming to identify the extent, range and nature of studies. Data will be extracted on populations, study designs, results and recommendations. Results will be visualised in charts alongside a descriptive qualitative synthesis. Results: Expected June 2016

Local Source Tsunami Inundation Modelling for Poverty Bay, Gisborne

After the Boxing Day 2004 Sumatran Tsunami, a review of tsunami hazard and risk for New Zealand identified Gisborne as the urban area with the greatest risk. Gisborne could experience gt;500 fatalities and extensive damage to infrastructure during a severe tsunami. The severity of a tsunami is likely to be low for distance sources given the effectiveness of the Pacific Tsunami Warning System. However, there is a substantial risk from local sources, as no local warning system of any kind exists. Prompt evacuation is probably the most cost-effective tsunami mitigation strategy available for New Zealand coastal locations, including Gisborne. This requires both knowledge of the extent of tsunami inundation, and sufficient warning of the tsunami arrival. Hence, there are two main objectives for this investigation: 1. Determine the likely extent of tsunami inundation for Gisborne City and surrounding populated coastal locations in Poverty Bay, using a combination of hydrodynamic tsunami modelling and GIS. The modelling will simulate historical events, particularly the largest historical tsunami, the May 1947 local tsunami. Modelling will consider potential events based on the Maximum Credible Earthquake for local sources associated with the Hikurangi Deformation Front. 2. Create inundation maps of Poverty Bay that can be used for future town planning and emergency plans

Lincolnshire exercise referral evaluation

This document reports on evaluation work completed by the University of Lincoln through the School of Sport and Exercise Science. It examines data stored on the Lincolnshire Sports Partnership’s parachute system regarding patients attending Lincolnshire’s Exercise Referral (ER) Programme, a service funded by Public Health. The analysis was in response to specific questions determined by exercise practitioners, the Lincolnshire Sports Partnership and Public Health Lincolnshire. Data was analysed via a number of statistical methods including Chi-squared and Logistic Regression. The data spanned a period of 3.5 years and included all patients in the database starting a 12-week ER programme between 10th March 2009 through to 22nd August 2012. There were 6637 eligible patients, of which 62.3% completed a 12-week ER programme. Headline findings from the evaluative research identified; 1) There was a significant relationship between those patients who completed the referral programme and a reduction in body mass index (BMI); 2) Those patients completing nine or more (out of 12) weeks of the referral programme were significantly more likely to complete. The number of sessions within a week did not influence completion; 3) There was a significantly increased likelihood for those patients who pay for exercise referral to complete the programme. This was regardless of the deprivation score of their home postcode and 4) There was no significant relationship between the way a referral is initiated and a patient completing a referral programme. More than half of these data were missing; however, hence the validity of this finding is impaired. These findings were used to generate recommendations regarding the data that is currently collected via the parachute system and the processes that are employed by the ER programmes

GN/C translation and rotation control parameters for AR/C (category 2)

Detailed analysis of the Automatic Rendezvous and Capture problem indicate a need for three different regions of mathematical description for the GN&C algorithms: (1) multi-vehicle orbital mechanics to the rendezvous interface point, i.e., within 100 n.; (2) relative motion solutions (such as Clohessy-Wiltshire type) from the far-field to the near-field interface, i.e., within 1 nm; and (3) close proximity motion, the nearfield motion where the relative differences in the gravitational and orbit inertial accelerations can be neglected from the equations of motion. This paper defines the reference coordinate frames and control parameters necessary to model the relative motion and attitude of spacecraft in the close proximity of another space system (Region 2 and 3) during the Automatic Rendezvous and Capture phase of an orbit operation

A Hamiltonian Formulation of the BKL Conjecture

The Belinskii, Khalatnikov and Lifshitz conjecture \cite{bkl1} posits that on approach to a space-like singularity in general relativity the dynamics are well approximated by `ignoring spatial derivatives in favor of time derivatives.' In \cite{ahs1} we examined this idea from within a Hamiltonian framework and provided a new formulation of the conjecture in terms of variables well suited to loop quantum gravity. We now present the details of the analytical part of that investigation. While our motivation came from quantum considerations, thanks to some of its new features, our formulation should be useful also for future analytical and numerical investigations within general relativity.Comment: 26 pages, 3 figures. Two references added. Minor typos corrected. To appear in PR

On the experimental testing of fine Nitinol wires for medical devices

Nitinol, a nickel titanium alloy, is widely used as a biocompatible metal with applications in high strain medical devices. The alloy exhibits both superelasticity and thermal shape memory behaviour. Basic mechanical properties can be established and are provided by suppliers; however the true stress–strain response under repeated load is not fully understood. It is essential to know this behaviour in order to design devices where failure by fatigue may be possible. The present work develops an approach for characterising the time varying mechanical properties of fine Nitinol wire and investigates processing factors, asymmetric stress–strain behaviour, temperature dependency, strain rate dependency and the material response to thermal and repeated mechanical loading. Physically realistic and accurately determined mechanical properties are provided in a format suitable for use in finite element analysis for the design of medical devices. Guidance is also given as to the most appropriate experimental set up procedures for gripping and testing thin Nitinol wire

Greenspan’s Monetary Policy in Retrospect: Discretion or Rules?

Is Alan Greenspan to blame for the current housing bubble and the ongoing financial crisis? A growing chorus charges the former Federal Reserve Chairman with being an "inflationist" whose loose monetary policy caused or significantly contributed to our current economic troubles. However, although Greenspan's policies weren't perfect, his monetary policy was in fact tight, and his legacy is one of having overseen low and stable inflation and a striking dampening of the business cycle. Critics charge Greenspan with having carried on an excessively expansionary monetary policy, particularly following the recession of 2001. They note how low interest rates were from 2002 through 2004 and argue that those low rates paved the way for everything from high prices at the pump to high prices at the supermarket, from the housing crisis to the financial crisis. In so doing, those critics make the classic mistake of using interest rates to evaluate monetary policy, reasoning that if interest rates are low, recent monetary policy must have been expansionary. It is not the Federal Reserve but supply and demand that ultimately determines interest rates. Although central banks can push rates up or down to some degree, the globally integrated financial system reduces the Fed’s ability to significantly influence rates. This paper should not be construed as a defense of all of Greenspan’s policies, nor of central banking or the Federal Reserve. In fact, our preference would be to abolish the Fed and deregulate the banking industry. Barring that, we argue that Federal Reserve policy ought to abide by the rules rather than the discretion of its chairman