Compressible flow structures interaction with a two-dimensional ejector: a cold-flow study

An experimental study has been conducted to examine the interaction of compressible flow structures such as shocks and vortices with a two-dimensional ejector geometry using a shock-tube facility. Three diaphragm pressure ratios ofP4 =P1 = 4, 8, and 12 have been employed, whereP4 is the driver gas pressure andP1 is the pressure within the driven compartment of the shock tube. These lead to incident shock Mach numbers of Ms = 1:34, 1.54, and 1.66, respectively. The length of the driver section of the shock tube was 700 mm. Air was used for both the driver and driven gases. High-speed shadowgraphy was employed to visualize the induced flowfield. Pressure measurements were taken at different locations along the test section to study theflow quantitatively. The induced flow is unsteady and dependent on the degree of compressibility of the initial shock wave generated by the rupture of the diaphragm

The views of older women towards mammographic screening: a qualitative and quantitative study

Purpose: Mammographic screening has improved breast cancer survival in the screened age group. This improved survival has not been seen in older women (>70 years) where screening uptake is low. This study explores the views, knowledge and attitudes of older women towards screening. Methods: Women (>70) were interviewed about breast screening. Interview findings informed the development of a questionnaire which was sent to 1000 women (>70) to quantify their views regarding screening. Results: Twenty-six women were interviewed and a questionnaire designed. The questionnaire response rate was 48.3% (479/992). Over half (52.9%, 241/456) of respondents were unaware they could request mammography by voluntary self-referral and were unaware of how to arrange this. Most (81.5% 383/470) had not attended breast screening since turning 70. Most (75.6%, 343/454) felt screening was beneficial and would attend if invited. Most, (90.1%, 412/457) felt screening should be offered to all women regardless of age or health. Conclusions: There is a lack of knowledge about screening in older women. The majority felt that invitation to screening should be extended to the older age group regardless of age or health. The current under-utilised system of voluntary self referral is not supported by older women

Drama, performance and touch in the medieval convent and beyond

In this analysis we explore the sensory performances of the performer, rather than the spectator, in medieval convent drama, particularly the tactile experiences of clothing, props, wigs, and beards worn by female performers presenting male and female characters

Rethinking the politics of gender and agency: an encounter with the ‘otherness’ of medieval Japan

This article engages with recent debates within feminism itself to rethink women, gender, body, and agency as conceptual categories for reading medieval Japanese literary/Buddhist texts. It questions the unreflexive transposition of contemporary understandings of concepts to the past, on the grounds that this produces anachronistic readings of the worlds we seek to understand. It argues that in medieval Japanese texts gender did not function as a ‘social’ category posited against the ‘natural’ fact of sex, and that gender was a kind of script and that it was the specificity of the gendered performance, rather than the sexual attributes and reproductive functions of the body, that gave substance to the categories ‘male’ and ‘female.’ The article also offers a critique of contemporary uses of the term agency in analyses of women and Buddhism in medieval Japan, arguing that agency here is defined as something possessed by autonomous individuals with free will, whose natural inclination is to strive to resist against the oppressive conditions of their lives. This modern liberal conception of agency, which is secular in nature, grants agency to humans alone. This anthropocentric view of the world necessitates the evisceration of the agency of gods, buddhas, dreams and material objects, all of whom are central actors in the cosmological/social world of medieval Japan

Burnt and Blossoming: Material Mysticism in Trilogy and Four Quartets

This paper brings two WWII poems into dialogue: H.D.'s Trilogy and Eliot's Four Quartets. Both poems express a creative response to the destruction of war. My reading of Trilogy suggests a material mysticism in which vision and renewal are situated within the natural world, rituals and bodily experience. Bringing this understanding of mysticism to bear on Four Quartets reveals tension between transcendence and materiality. For Eliot, redemption comes through time and location, while for H.D., redemption lies within material particularity. Four Quartets oscillates between an apophatic discourse that seeks to transcend desire and history and an emphasis on material particularities

Standard set of health outcome measures for older persons

Background: The International Consortium for Health Outcomes Measurement (ICHOM) was founded in 2012 to propose consensus-based measurement tools and documentation for different conditions and populations.This article describes how the ICHOM Older Person Working Group followed a consensus-driven modified Delphi technique to develop multiple global outcome measures in older persons. The standard set of outcome measures developed by this group will support the ability of healthcare systems to improve their care pathways and quality of care. An additional benefit will be the opportunity to compare variations in outcomes which encourages and supports learning between different health care systems that drives quality improvement. These outcome measures were not developed for use in research. They are aimed at non researchers in healthcare provision and those who pay for these services. Methods: A modified Delphi technique utilising a value based healthcare framework was applied by an international panel to arrive at consensus decisions.To inform the panel meetings, information was sought from literature reviews, longitudinal ageing surveys and a focus group. Results: The outcome measures developed and recommended were participation in decision making, autonomy and control, mood and emotional health, loneliness and isolation, pain, activities of daily living, frailty, time spent in hospital, overall survival, carer burden, polypharmacy, falls and place of death mapped to a three tier value based healthcare framework. Conclusions: The first global health standard set of outcome measures in older persons has been developed to enable health care systems improve the quality of care provided to older persons

Outlining a new collaborative business model as a result of the green Building Information Modelling impact in the AEC supply chain

BIM (Building Information Modelling) technological push has enabled to integrate the design/construction outcomes of 3D-CAD along the product/service AEC (Architecture, Engineering and Construction) SC (supply chain) through an intelligent DMS (Data Management System) based on standard and interoperable data formats. The proposed end-to-end approach overcomes a typical AEC gap, enables the operationalisation of the sustainable/green building LCA (Life Cycle Assessment) and puts together new collaborative relationships with the owner, among SC stakeholders and with new forms of BIM procurement. The outlined collaborative business model is based on the Quality Control and Assurance framework and provides conceptual consistency to the reintroduction of the owner concerns/satisfaction in the SC, as well as enables consistent and accountable relationships between (smart)materials procurement and building specification. An expert’s focus group carried out a preliminary check of the model’s interest/applicability, resulting in recommendations for its further detailing and for propositions development into a systematic enquiring process.info:eu-repo/semantics/acceptedVersio

Epidemiology and outcomes of people with dementia, delirium and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions

Background  Cognitive impairment of various kinds is common in older people admitted to hospital, but previous research has usually focused on single conditions in highly-selected groups and has rarely examined associations with outcomes. This study examined prevalence and outcomes of cognitive impairment in a large unselected cohort of people aged 65+ with an emergency medical admission.  Methods  Between January 1, 2012, and June 30, 2013, admissions to a single general hospital acute medical unit aged 65+ underwent a structured specialist nurse assessment (n = 10,014). We defined ‘cognitive spectrum disorder’ (CSD) as any combination of delirium, known dementia, or Abbreviated Mental Test (AMT) score < 8/10. Routine data for length of stay (LOS), mortality, and readmission were linked to examine associations with outcomes.  Results  A CSD was present in 38.5% of all patients admitted aged over 65, and in more than half of those aged over 85. Overall, 16.7% of older people admitted had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% unspecified cognitive impairment (AMT score < 8/10, no delirium, no known dementia). Of those with known dementia, 45.8% had delirium superimposed. Outcomes were worse in those with CSD compared to those without – LOS 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year death or readmission 62.4% vs. 51.5% (allP < 0.01). There was relatively little difference by CSD type, although people with delirium superimposed on dementia had the longest LOS, and people with dementia the worst mortality at 1 year.  Conclusions  CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on condition-specific pathways such as those for dementia or delirium alone

Dementia as a determinant of social and health service use in the last two years of life 1996-2003

<p>Abstract</p> <p>Background</p> <p>Dementia is one of the most common causes of death among old people in Finland and other countries with high life expectancies. Dementing illnesses are the most important disease group behind the need for long-term care and therefore place a considerable burden on the health and social care system. The aim of this study was to assess the effects of dementia and year of death (1998-2003) on health and social service use in the last two years of life among old people.</p> <p>Methods</p> <p>The data were derived from multiple national registers in Finland and comprise all those who died in 1998, 2002 or 2003 and 40% of those who died in 1999-2001 at the age of 70 or over (n = 145 944). We studied the use of hospitals, long-term care and home care in the last two years of life. Statistics were performed using binary logistic regression analyses and negative binomial regression analyses, adjusting for age, gender and comorbidity.</p> <p>Results</p> <p>The proportion of study participants with a dementia diagnosis was 23.5%. People with dementia diagnosis used long-term care more often (OR 9.30, 95% CI 8.60, 10.06) but hospital (OR 0.33, 95% CI 0.31, 0.35) and home care (OR 0.50, 95% CI 0.46, 0.54) less often than people without dementia. The likelihood of using university hospital and long-term care increased during the eight-year study period, while the number of days spent in university and general hospital among the users decreased. Differences in service use between people with and without dementia decreased during the study period.</p> <p>Conclusions</p> <p>Old people with dementia used long-term care to a much greater extent and hospital and home care to a lesser extent than those without dementia. This difference persisted even when controlling for age, gender and comorbidity. It is important that greater attention is paid to ensuring that old people with dementia have equitable access to care.</p