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Despite calls for better support to empower people when reassessing their housing in later life, two recent literature reviews highlight a paucity of research on the efficacy of such services. This article reports a qualitative realist evaluation on the efficacy of a UK telephone service providing information on specialist housing to older people. The findings of thirty-one realist interviews with sixteen older people are presented. Information-seekers’ existing tenure (social tenant or private owner-occupier/renter) shaped their experience and utilisation of support. Broadly, however, information was considered too ‘light touch’ to empower older people. However, the widely recognised lack of accessible housing options and reports of non-transparent and unresponsive market practices were also key factors. This study underlines the widely acknowledged need to increase the supply of specialist housing, and recommends that housing options support be reflective of market conditions and be more substantive – including discussion, deliberation, education and advocacy.
The origins of agriculture in South-west Asia is a topic of continued archaeological debate. Of particular interest is how agricultural populations and practices spread inter-regionally. Was the Arabian Neolithic, for example, spread through the movement of pastoral groups, or did ideas perhaps develop independently? Here, the authors report on recent excavations at Alshabah, one of the first Neolithic sites discovered in Northern Arabia. The site’s material culture, environmental context and chronology provide evidence suggesting that well-adapted, seasonally mobile, pastoralist groups played a key role in the Neolithisation of the Arabian Peninsula.
We present simultaneous two-dimensional velocity and scalar measurements on a central vertical plane in an axisymmetric pure turbulent plume. We use an edge-detection algorithm to determine the edge of the plume, and compare the data obtained in both a fixed Eulerian frame and a frame relative to local coordinates defined in terms of the instantaneous plume edge. In an Eulerian frame we observe that the time-averaged distributions of vertical and horizontal velocity are self-similar, the vertical velocity being well represented by a Gaussian distribution. We condition these measurements on whether fluid is inside or outside of the plume, and whether fluid inside is mixed plume fluid or engulfed ambient fluid. We find that, on average, 5 % of the total vertical volume transport occurs outside the plume and this figure rises to nearly 14 % at heights between large-scale coherent structures. We show that the fluxes of engulfed fluid within the plume envelope are slightly larger than the vertical transport outside the plume – indicating that ambient fluid is engulfed into the plume envelope before being nibbled across the turbulent/non-turbulent interface (TNTI) and then ultimately irreversibly mixed. Our new measurements in the plume coordinate (following the meandering fluctuating plume) show the flow within the plume and in the nearby ambient fluid is strongly influenced by whether an eddy is present locally within the plume, or absent. When an eddy is present and the plume is wide, the vertical velocities near the plume edge are small and hence all vertical transport is inside the plume. In regions where the plume is narrow and there is no eddy, large vertical velocities and hence transport are observed outside the plume suggesting that pressure forces associated with the eddies accelerate ambient fluid which is then engulfed into the plume. Finally, we show that observing significant vertical velocities beyond the scalar edge of the plume does not suggest that the characteristic width of the velocity distribution is greater than that of the scalar field; on the contrary, we show our observations to be consistent with a buoyancy distribution that is up to 20 % wider than that of the velocity. Measurements in the plume coordinates show that the mixing of momentum across the plume results in a distribution for which the differential entropy is close to maximal and the mixing of momentum is uninhibited (i.e. not bounded) by the TNTI of the plume. Furthermore, our measurements suggest that the scalar mixing across the plume may also result in a distribution for which the differential entropy is close to maximal but, in contrast to the momentum, the scalar mixing is strictly bounded by the plume edge.
A measles outbreak occurred in a school in a small town in the South East of Ireland in September–November 2013. Most (and all early) cases had one dose of the measles-mumps- rubella (MMR) vaccination. All suspected cases were followed up, in order to advise on sampling and provide public health advice to them and their contacts. MMR vaccination control measures were instituted in the town. These included early second MMR in primary schools and childcare facilities, bringing forward the planned school MMR catch-up programme, early first MMR dose for children aged 6–12 months and targeted advice to unvaccinated children. There were 20 cases (17 confirmed) of measles associated with the outbreak. Fifteen cases occurred in the index school, with four in pre-school-age children (<4 years) who had clear epidemiological links with children at the school. This was a well-circumscribed outbreak occurring, unusually, in a well-vaccinated population. The outbreak came late to the attention of Department of Public Health staff but prompt action, once notified, and institution of control measures resulted in quick termination of the outbreak and prevention of cases in a neighbouring city.
Endeavours to control urogenital schistosomiasis on Unguja Island (Zanzibar) have focused on school-aged children. To assess the impact of an associated health education campaign, the supervised use of the comic-strip medical booklet Juma na Kichocho by Class V pupils attending eighteen primary schools was investigated. A validated knowledge and attitudes questionnaire was completed at baseline and repeated one year later following the regular use of the booklet during the calendar year. A scoring system (ranging from 0.0 to 5.0) measured children’s understandings of schistosomiasis and malaria, with the latter being a neutral comparator against specific changes for schistosomiasis. In 2006, the average score from 751 children (328 boys and 423 girls) was 2.39 for schistosomiasis and 3.03 for malaria. One year later, the score was 2.43 for schistosomiasis and 2.70 for malaria from 779 children (351 boys and 428 girls). As might be expected, knowledge and attitudes scores for schistosomiasis increased (+0.05), but not as much as originally hoped, while the score for malaria decreased (−0.33). According to a Kolmogorov–Smirnov test, neither change was statistically significant. Analysis also revealed that 75% of school children misunderstood the importance of reinfection after treatment with praziquantel. These results are disappointing. They demonstrate that it is mistaken to assume that knowledge conveyed in child-friendly booklets will necessarily be interpreted, and acted upon, in the way intended. If long-term sustained behavioural change is to be achieved, health education materials need to engage more closely with local understandings and responses to urogenital schistosomiasis. This, in turn, needs to be part of the development of a more holistic, biosocial approach to the control of schistosomiasis.
A scaling theory of long-wavelength electrostatic turbulence in a magnetised, weakly collisional plasma (e.g. drift-wave turbulence driven by ion temperature gradients) is proposed, with account taken both of the nonlinear advection of the perturbed particle distribution by fluctuating
flows and of its phase mixing, which is caused by the streaming of the particles along the mean magnetic field and, in a linear problem, would lead to Landau damping. It is found that it is possible to construct a consistent theory in which very little free energy leaks into high velocity moments of the distribution function, rendering the turbulent cascade in the energetically relevant part of the wavenumber space essentially fluid-like. The velocity-space spectra of free energy expressed in terms of Hermite-moment orders are steep power laws and so the free-energy content of the phase space does not diverge at infinitesimal collisionality (while it does for a linear problem); collisional heating due to long-wavelength perturbations vanishes in this limit (also in contrast with the linear problem, in which it occurs at the finite rate equal to the Landau damping rate). The ability of the free energy to stay in the low velocity moments of the distribution function is facilitated by the ‘anti-phase-mixing’ effect, whose presence in the nonlinear system is due to the stochastic version of the plasma echo (the advecting velocity couples the phase-mixing and anti-phase-mixing perturbations). The partitioning of the wavenumber space between the (energetically dominant) region where this is the case and the region where linear phase mixing wins its competition with nonlinear advection is governed by the ‘critical balance’ between linear and nonlinear time scales (which for high Hermite moments splits into two thresholds, one demarcating the wavenumber region where phase mixing predominates, the other where plasma echo does).
Agriculture is a largely technical endeavour involving complicated managerial decision-making that affects crop performance. Farm-level modelling integrates crop models with agent behaviour to account for farmer decision-making and complete the representation of agricultural systems. To replicate an important part of agriculture in Central Europe a crop model was calibrated for a unique region's predominant crops: winter wheat, winter and spring barley, silage maize and winter rapeseed. Their cultivation was then simulated over multiple decades at daily resolution to test validity and stability, while adding the dimension of agent behaviour in relation to environmental and economic conditions. After validation against regional statistics, simulated future weather scenarios were used to forecast crop management and performance under anticipated global change. Farm management and crop genetics were treated as adaptive variables in the milieu of shifting climatic conditions to allow projections of agriculture in the study region into the coming decades.
Antimicrobial stewardship programs are increasingly recognized as critical in optimizing the use of antimicrobials. Consequently, more physicians, pharmacists, and other healthcare providers are developing and implementing such programs in a variety of healthcare settings. The purpose of this guidance document is to outline the knowledge and skills that are needed to lead an antimicrobial stewardship program. It was developed by antimicrobial stewardship experts from organizations that are engaged in advancing the field of antimicrobial stewardship.
Infect Control Hosp Epidemiol 2014;35(12):1444–1451
This research implements a recently proposed framework for meander migration, in order to explore the coevolution of planform and channel width in a freely meandering river. In the model described here, width evolution is coupled to channel migration through two submodels, one describing bank erosion and the other describing bank deposition. Bank erosion is modelled as erosion of purely non-cohesive bank material damped by natural armouring due to basal slump blocks, and bank deposition is modelled in terms of a flow-dependent rate of vegetal encroachment. While these two submodels are specified independently, the two banks interact through the medium of the intervening channel; the morphodynamics of which is described by a fully nonlinear depth-averaged morphodynamics model. Since both banks are allowed to migrate independently, channel width is free to vary locally as a result of differential bank migration. Through a series of numerical runs, we demonstrate coevolution of local curvature, width and streamwise slope as the channel migrates over time. The correlation between the local curvature, width and bed elevation is characterized, and the nature of this relationship is explored by varying the governing parameters. The results show that, by varying a parameter representing the ratio between a reference bank erosion rate and a reference bank deposition rate, the model is able to reproduce the broad range of river width–curvature correlations observed in nature. This research represents a step towards providing general metrics for predicting width variation patterns in river systems.
Dementia is a complex and variable condition which makes recognition of it particularly difficult in a low prevalence primary care setting. This study examined the factors associated with agreement between an objective measure of cognitive function (the revised Cambridge Cognitive Assessment, CAMCOG-R) and general practitioner (GP) clinical judgment of dementia.
This was a cross-sectional study involving 165 GPs and 2,024 community-dwelling patients aged 75 years or older. GPs provided their clinical judgment in relation to each of their patient's dementia status. Each patient's cognitive function and depression status was measured by a research nurse using the CAMCOG-R and the 15-item Geriatric Depression Scale (GDS), respectively.
GPs correctly identified 44.5% of patients with CAMCOG-R dementia and 90% of patients without CAMCOG-R dementia. In those patients with CAMCOG-R dementia, two patient-dependent factors were most important for predicting agreement between the CAMCOG-R and GP judgment: the CAMCOG-R score (p = 0.006) and patient's mention of subjective memory complaints (SMC) to the GP (p = 0.040). A higher CAMCOG-R (p < 0.001) score, female gender (p = 0.005), and larger practice size (p < 0.001) were positively associated with GP agreement that the patient did not have dementia. Subjective memory complaints (p < 0.001) were more likely to result in a false-positive diagnosis of dementia.
Timely recognition of dementia is advocated for optimal dementia management, but early recognition of a possible dementia syndrome needs to be balanced with awareness of the likelihood of false positives in detection. Although GPs correctly agree with dimensions measured by the CAMCOG-R, improvements in sensitivity are required for earlier detection of dementia.
We present new radial velocities for 306 bright (R < 16) galaxies in a 77 deg2 region of the Shapley supercluster, measured with the FLAIR-II spectrograph on the UK Schmidt Telescope. The galaxies we measured were uniformly distributed over the survey area, in contrast to previous samples which were concentrated in several rich Abell clusters. Most of the galaxies (230) were members of the Shapley supercluster: they trace out two previously unknown sheets of galaxies linking the Abell clusters of the supercluster. In a 44 deg2 area of the supercluster excluding the Abell clusters, these sheets alone represent an overdensity of a factor of 2·0 ± 0·2 compared to a uniform galaxy distribution. The supercluster is not flattened in the Declination direction as has been suggested in previous papers. Within our survey area the new galaxies contribute an additional 50% to the known contents of the Shapley supercluster, with a corresponding increase in its contribution to the motion of the Local Group.
Background: Identification of factors associated with quality of life (QoL) in people having dementia will help develop strategies for maintenance and improvement of patient QoL. This study examined the predictors of QoL in a community-dwelling population aged 75 years and over, with or without dementia.
Methods: This was a cross-sectional study involving 169 GPs and 2,028 patients. Patients were interviewed to collect information on personal circumstances. Several instruments were administered including the WHOQOL-BREF (quality of life outcome measure), Geriatric Depression Scale, GPAQ (satisfaction with GP care), and the CAMCOG-R (cognitive function). Patients with a CAMCOG-R score < 80 were allocated to the dementia group. GPs provided an independent clinical judgment of cognitive function for each of their participating patients.
Results: The dementia group had significantly lower QoL scores in all four domains of the WHOQOL-BREF (all p ≤ 0.002). The GDS score was negatively correlated with all four domains in the non-dementia group and with physical, psychological, and environmental QoL in the dementia group (all p < 0.001). Satisfaction with GP communication was positively associated with psychological QoL in the dementia group and all domains in the non-dementia group. Participants in the dementia group who had been given a diagnosis of a memory problem had significantly higher physical (2.05, 95% CI 0.36 to 3.74) and environmental (2.18, 95% CI 0.72 to 3.64) QoL.
Conclusions: Satisfaction with GP communication is associated with a higher QoL in their older patients. Diagnosis and disclosure of memory problems is associated with better QoL in people with dementia. Clinicians should not be deterred from discussing a memory diagnosis and plans for the future with patients.
We are presently using the Chandra X-ray Observatory to conduct the first systematic X-ray survey of planetary nebulae (PNe) in the solar neighborhood. The Chandra Planetary Nebula Survey (ChanPlaNS) is a 570 ks Chandra Cycle 12 Large Program targeting 21 high-excitation PNe within ~1.5 kpc of Earth. When complete, this survey will provide a suite of new X-ray diagnostics that will inform the study of late stellar evolution, binary star astrophysics, and wind interactions. Among the early results of ChanPlaNS (when combined with archival Chandra data) is a surprisingly high detection rate of relatively hard X-ray emission from CSPNe. Specifically, X-ray point sources are clearly detected in roughly half of the ~30 high-excitation PNe observed thus far by Chandra, and all but one of these X-ray-emitting CSPNe display evidence for a hard (few MK) component in their Chandra spectra. Only the central star of the Dumbbell appears to display “pure” hot blackbody emission from a ~200 kK hot white dwarf photosphere in the X-ray band. Potential explanations for the“excess” hard X-ray emission detected from the other CSPNe include late-type companions (heretofore undetected, in most cases) whose coronae have been rejuvenated by recent interactions with the mass-losing WD progenitor, non-LTE effects in hot white dwarf photospheres, self-shocking variable winds from the central star, and slow (re-)accretion of previously ejected red giant envelope mass.
We present a study of a complex ultra-high-strength Al alloy containing ~40 volume per cent of second-phase particles, ranging in size from nanometres to a few microns. The microstructure has been investigated using scanning electron microscopy and high-resolution synchrotron X-ray diffraction using the I11 beam line at the Diamond Light Source, UK. Powder diffraction was carried out to (i) determine phases present, (ii) quantify the weight per cent of each phase and (iii) quantify size and strain effects in the Al matrix. The high beam quality (i.e. low divergence and wavelength purity) and multi-analysing crystal detectors makes this an ideal instrument to resolve the high peak density and determine the contribution of sample broadening in the complex alloy. Using Pawley and Rietveld full pattern fitting, the intermetallic phases present were determined to be Al3Ti, Al13Cr2 and Al13Fe4. The weight fraction of each phase was calculated from the Rietveld refinements and correlated well with thermodynamic calculations assuming an equilibrium microstructure. Size and strain in the Al matrix was measured from peak broadening using a Double Voigt analysis and showed significant physical broadening due to both size and strain.
Commercially farmed animals are frequently housed in conditions that impose a number of concurrent environmental stressors. For pigs housed indoors, elevated levels of mechanical noise, atmospheric ammonia and low light intensities are commonplace. This experiment examined the effects on growing pigs of chronic exposure to combinations of commercially relevant levels of these potential stressors. Four-week-old hybrid female pigs (n = 224) were housed under experimentally manipulated conditions of nominally either <5 or 20 ppm atmospheric concentration of ammonia (24 h), a light intensity of 40 lux or 200 lux (12 h) and mechanical noise at either ⩽60 or 80 dB(A) (24 h) for 15 weeks in a fully factorial arrangement (23) of treatments. The response of pigs to these environmental factors was assessed using a suite of physiological, production and behavioural measures. These included indicators of hypothalamic–pituitary–adrenal (HPA) axis activation such as salivary cortisol and adrenal morphometry, as well as body weight, food conversion efficiency and general health scores. Play behaviour was recorded as it is thought to be inversely related to stress. Chronic exposure to ammonia produced the strongest effect, shown by lower concentrations of salivary cortisol and larger adrenal cortices in the pigs reared under 20 ppm ammonia, which may have been indicative of a period of HPA activation leading to a downregulation of cortisol production. The pigs in the ammoniated rooms also performed less play behaviour than pigs in non-ammoniated rooms. There was evidence for an interaction between high noise and ammonia on the health scores of pigs and for brighter light to ameliorate the effect of ammonia on salivary cortisol. However, there was no measurable impact of these potential stressors on the productivity of the pigs or any of the other physiological parameters measured. We conclude that there should be little concern in terms of performance about the physical stressors tested here, within current European Union legal limits. However, 20 ppm ammonia may have had an adverse influence on the well-being of growing pigs. In this study, all other aspects of the pigs’ husbandry were optimal; therefore, it is possible that under less favourable conditions, more pronounced effects of ammonia, noise and dim light would be observed.
The effects of common and concurrent environmental stressors on the social behaviour of farm animals are poorly understood. Here, we report the results of a multifactorial experiment designed specifically to examine the individual, additive or interactive effects of elevated ammonia, noise and low light (LL) levels on the social behaviour of growing pigs. Social behaviour was measured in terms of the nature, frequency and duration of both initiated and response behaviours for 4 weeks following mixing of the groups. General activity patterns, group cohesion and social discrimination were also examined as a function of the environmental treatments. Elevated concentrations of atmospheric ammonia (∼20 v. <5 ppm) and LL intensity (∼40 v. 200 lux) had the most pronounced effects, particularly on the nature of social interactions, with pigs under these conditions showing more aggression in the early stages of the experiment. In addition, pigs exposed to a high level of mechanical noise representative of artificial ventilation (∼80 v. 40 dB [A]) were less submissive to aggressive acts, while pigs in ∼20 ppm ammonia showed more reciprocated aggression when in coincident LL (<40 lux). The results indicate that atmospheric ammonia at commonly experienced concentrations may undermine social stability, particularly in the presence of low lighting, though the mechanisms are currently unknown. These findings have implications for the welfare of growing pigs and hence policy makers and farmers alike, with respect to the improvement of welfare in intensive pig farming.