Daily average temperature and mortality among the elderly : a meta-analysis and systematic review of epidemiological evidence

The impact of climate change on the health of vulnerable groups such as the elderly has been of increasing concern. However, to date there has been no meta-analysis of current literature relating to the effects of temperature fluctuations upon mortality amongst the elderly. We synthesised risk estimates of the overall impact of daily mean temperature on elderly mortality across different continents. A comprehensive literature search was conducted using MEDLINE and PubMed to identify papers published up to December 2010. Selection criteria including suitable temperature indicators, endpoints, study-designs and identification of threshold were used. A two-stage Bayesian hierarchical model was performed to summarise the percent increase in mortality with a 1°C temperature increase (or decrease) with 95% confidence intervals in hot (or cold) days, with lagged effects also measured. Fifteen studies met the eligibility criteria and almost 13 million elderly deaths were included in this meta-analysis. In total, there was a 2-5% increase for a 1°C increment during hot temperature intervals, and a 1-2 % increase in all-cause mortality for a 1°C decrease during cold temperature intervals. Lags of up to 9 days in exposure to cold temperature intervals were substantially associated with all-cause mortality, but no substantial lagged effects were observed for hot intervals. Thus, both hot and cold temperatures substantially increased mortality among the elderly, but the magnitude of heat-related effects seemed to be larger than that of cold effects within a global context.

Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring

Background: Although the potential to reduce hospitalisation and mortality in chronic heart failure (CHF) is well reported, the feasibility of receiving healthcare by structured telephone support or telemonitoring is not. Aims: To determine; adherence, adaptation and acceptability to a national nurse-coordinated telephone-monitoring CHF management strategy. The Chronic Heart Failure Assistance by Telephone Study (CHAT). Methods: Triangulation of descriptive statistics, feedback surveys and qualitative analysis of clinical notes. Cohort comprised of standard care plus intervention (SC + I) participants who completed the first year of the study. Results: 30 GPs (70% rural) randomised to SC + I recruited 79 eligible participants, of whom 60 (76%) completed the full 12 month follow-up period. During this time 3619 calls were made into the CHAT system (mean 45.81 SD ± 79.26, range 0-369), Overall there was an adherence to the study protocol of 65.8% (95% CI 0.54-0.75; p = 0.001) however, of the 60 participants who completed the 12 month follow-up period the adherence was significantly higher at 92.3% (95% CI 0.82-0.97, p ≤ 0.001). Only 3% of this elderly group (mean age 74.7 ±9.3 years) were unable to learn or competently use the technology. Participants rated CHAT with a total acceptability rate of 76.45%. Conclusion: This study shows that elderly CHF patients can adapt quickly, find telephone-monitoring an acceptable part of their healthcare routine, and are able to maintain good adherence for a least 12 months. © 2007.

Thin bed masonry system: review and future prospects

Masonry is one of the most ancient construction materials in the World. When compared to other civil engineering practices, masonry construction is highly labour intensive, which can affect the quality and productivity adversely. With a view to improving quality and in light of the limited skilled labour in the recent times several innovative masonry construction methods such as the dry stack and the thin bed masonry have been developed. This paper focuses on the thin bed masonry system, which is used in many parts of Europe. Thin bed masonry system utilises thin layer of polymer modified mortars connecting the accurately dimensioned and/or interlockable units. This assembly process has the potential for automated panelised construction system in the industry setting or being adopted in the site using less skilled labour, without sacrificing the quality. This is because unlike the conventional masonry construction, the thin bed technology uses thinner mortar (or glue) layer which can be controlled easily through some novel methods described in this paper. Structurally, reduction in the thickness of the mortar joint has beneficial effects; for example it increases the compressive strength of masonry; in addition polymer added glue mortar enhances lateral load capacity relative to conventional masonry. This paper reviews the details of the recent research outcomes on the structural characteristics and construction practices of thin bed masonry. Finally the suitability of thin bed masonry in developing countries where masonry remains as the most common material for residential building construction is discussed.

Feasibility study for thermal treatment of solid tire wastes in Bangladesh by using pyrolysis technology

In this study on the basis of lab data and available resources in Bangladesh, feasibility study has been carried out for pyrolysis process converting solid tire wastes into pyrolysis oils, solid char and gases. The process considered for detailed analysis was fixed-bed fire-tube heating pyrolysis reactor system. The comparative techno-economic assessment was carried out in US$ for three different sizes plants: medium commercial scale (144 tons/day), small commercial scale (36 tons/day), pilot scale (3.6 tons/day). The assessment showed that medium commercial scale plant was economically feasible, with the lowest unit production cost than small commercial and pilot scale plants for the production of crude pyrolysis oil that could be used as boiler fuel oil and for the production of upgraded liquid-products.

Fixed bed pyrolysis of date seed waste for liquid oil production

The conversion of biomass waste in the form of date seed into pyrolysis oil by fixed bed pyrolysis reactor has been taken into consideration in this study. A fixed bed pyrolysis has been designed and fabricated for obtaining liquid fuel from these date seeds. The major component of the system are fixed bed pyrolysis reactor, liquid condenser and liquid collector. The date seed in particle form is pyrolysed in an externally heated 7.6 cm diameter and 46 cm high fixed bed reactor with nitrogen as the carrier gas. The reactor is heated by means of a biomass source cylindrical heater from 4000C to 6000C. The products are oil, char and gas. The reactor bed temperature, running time and feed particle size are considered as process parameters. The parameters are found to influence the product yield significantly. A maximum liquid yield of 50 wt.% is obtained at a reactor bed temperature of 5000 C for a feed size volume of 0.11- 0.20 cm3 with a running time of 120 minutes. The pyrolysis oil obtained at this optimum process conditions are analyzed for some fuel properties and compared with some other biomass derived pyrolysis oils and also with conventional fuels. The oil is found to possess favorable flash point and reasonable density and viscosity. The higher calorific value is found to be 28.636 MJ/kg which is significantly higher than other biomass derived pyrolysis oils.

Fixed bed pyrolysis of pulm seed waste for liquid oil production

Among various thermo-chemical conversion processes, pyrolysis is considered as an emerging technology for liquid oil production. The conversion of biomass waste in the form of plum seed into pyrolysis oil by fixed bed pyrolysis reactor has been taken into consideration in this study. A fixed bed pyrolysis has been designed and fabricated for obtaining liquid fuel from this plum seeds. The major component of the system are fixed bed pyrolysis reactor, liquid condenser and liquid collectors. The plum seed in particle form is pyrolysed in an externally heated 7.6 cm diameter and 46 cm high fixed bed reactor with nitrogen as the carrier gas. The reactor is heated by means of a biomass source cylindrical heater from 4000C to 6000C. The products are oil, char and gas. The reactor bed temperature, running time and feed particle size are considered as process parameters. The parameters are found to influence the product yield significantly. A maximum liquid yield of 39 wt% of biomass feed is obtained with particle size of 2.36-4.75 mm at a reactor bed temperature of 520oC with a running time of 120 minutes. The pyrolysis oil obtained at this optimum process conditions are analyzed for some fuel properties and compared with some other biomass derived pyrolysis oils and conventional fuels. The oil is found to possess favorable flash point and reasonable density and viscosity. The higher calorific value is found to be 22.39 MJ/kg which is higher than other biomass derived pyrolysis oils.

Production of liquid fuel and activated carbon from mahogany seed by using pyrolysis technology

The renovation of biomass waste in the form of Mahogany seed waste into bio-fuel as well as activated carbon by fixed bed pyrolysis reactor has been taken into consideration in this study. The mahogany seed in particle form is pyrolyzed in an enormously heated fixed bed reactor with nitrogen as the carrier gas. The reactor is heated from 4000C to 6000C using a external heater in which rice husk and charcoal are used as the heater biomass fuel. Reactor bed temperature, running time and feed particle size have been varied to get the optimum operating conditions of the system. The parameters are found to influence the product yields to a large extent. A maximum liquid and char yield are 49 wt. % and 35 wt. % respectively obtained at a reactor bed temperature 5000C when the running time is 90 minutes. Acquired pyrolyzed oil at these optimal process conditions were analyzed for some of their properties as an alternative fuel. The oil possesses comparable flame temperature, favorable flash point and reasonable viscosity along with somewhat higher density. The kinematic viscosity of the derived fuel is 3.8 cSt and density is 1525 kg/m3. The higher calorific value is found 32.4 MJ/kg which is significantly higher than other biomass derived fuel. Moderate adsorption capacity of the prepared activated carbon in case of methyl blue & tea water was also revealed.

Influence of atmospheric sublimation and evaporation on the heat pump fluid bed drying of bovine intestines

Experiments on atmospheric two-stage fluidized bed drying of bovine intestines with heat pump were carried out. The investigation covers innovative fluidized bed heat pump drying of bovine intestines. The two-stage drying consists of atmospheric moisture sublimation immediately followed by evaporation. Studies were done to establish the influence of the drying condition on the drying characteristics and product quality of bovine intestines and properties focusing on kinetics, diffusion, and color. The investigation of the drying characteristics has been conducted during moisture removal by evaporation and combined sublimation and evaporation. The effect of drying temperature on the drying constants was determined by fitting the experimental data using regression analysis techniques. The investigation revealed that the drying kinetics is most significantly affected by temperature. Correlations expressing the drying constants and effective moisture diffusivity dependence on the drying conditions are reported.

Influence of drying conditions on the moisture diffusion during single stage and two stage fluidized bed drying of bovine intestine for pet food

Bovine intestine samples were heat pump fluidized bed dried at atmospheric pressure and at temperatures below and above the material freezing points equipped with a continuous monitoring system. The investigation of the drying characteristics has been conducted in the temperature range -10~25oC and the airflow in the range 1.5~2.5 m/s. Some experiments were conducted as a single temperature drying experiments and others as two stage drying experiments employing two temperatures. An Arrhenius-type equation was used to interpret the influence of the drying air parameters on the effective diffusivity, calculated with the method of slopes in terms of energy activation, and this was found to be sensitivity of the temperature. The effective diffusion coefficient of moisture transfer was determined by Fickian method using uni-dimensional moisture movement in both moisture, removal by evaporation and combined sublimation and evaporation. Correlations expressing the effective moisture diffusivity and drying temperature are reported.

Encouraging, assisting, and time to eat : comparison of mealtime assistance interventions in elderly medical inpatients

BACKGROUND: The prevalence of protein-energy malnutrition in older adults is reported to be as high as 60% and is associated with poor health outcomes. Inadequate feeding assistance and mealtime interruptions may contribute to malnutrition and poor nutritional intake during hospitalisation. Despite being widely implemented in practice in the United Kingdom and increasingly in Australia, there have been few studies examining the impact of strategies such as Protected Mealtimes and dedicated feeding assistant roles on nutritional outcomes of elderly inpatients. AIMS: The aim of this research was to implement and compare three system-level interventions designed to specifically address mealtime barriers and improve energy intakes of medical inpatients aged ≥65 years. This research also aimed to evaluate the sustainability of any changes to mealtime routines six months post-intervention and to gain an understanding of staff perceptions of the post-intervention mealtime experience. METHODS: Three mealtime assistance interventions were implemented in three medical wards at Royal Brisbane and Women's Hospital: AIN-only: Additional assistant-in-nursing (AIN) with dedicated nutrition role. PM-only: Multidisciplinary approach to meals, including Protected Mealtimes. PM+AIN: Combined intervention: AIN + multidisciplinary approach to meals. An action research approach was used to carefully design and implement the three interventions in partnership with ward staff and managers. Significant time was spent in consultation with staff throughout the implementation period to facilitate ownership of the interventions and increase likelihood of successful implementation. A pre-post design was used to compare the implementation and nutritional outcomes of each intervention to a pre-intervention group. Using the same wards, eligible participants (medical inpatients aged ≥65 years) were recruited to the preintervention group between November 2007 and March 2008 and to the intervention groups between January and June 2009. The primary nutritional outcome was daily energy and protein intake, which was determined by visually estimating plate waste at each meal and mid-meal on Day 4 of admission. Energy and protein intakes were compared between the pre and post intervention groups. Data were collected on a range of covariates (demographics, nutritional status and known risk factors for poor food intake), which allowed for multivariate analysis of the impact of the interventions on nutritional intake. The provision of mealtime assistance to participants and activities of ward staff (including mealtime interruptions) were observed in the pre-intervention and intervention groups, with staff observations repeated six months post-intervention. Focus groups were conducted with nursing and allied health staff in June 2009 to explore their attitudes and behaviours in response to the three mealtime interventions. These focus group discussions were analysed using thematic analysis. RESULTS: A total of 254 participants were recruited to the study (pre-intervention: n=115, AIN-only: n=58, PM-only: n=39, PM+AIN: n=42). Participants had a mean age of 80 years (SD 8), and 40% (n=101) were malnourished on hospital admission, 50% (n=108) had anorexia and 38% (n=97) required some assistance at mealtimes. Occasions of mealtime assistance significantly increased in all interventions (p<0.01). However, no change was seen in mealtime interruptions. No significant difference was seen in mean total energy and protein intake between the preintervention and intervention groups. However, when total kilojoule intake was compared with estimated requirements at the individual level, participants in the intervention groups were more likely to achieve adequate energy intake (OR=3.4, p=0.01), with no difference noted between interventions (p=0.29). Despite small improvements in nutritional adequacy, the majority of participants in the intervention groups (76%, n=103) had inadequate energy intakes to meet their estimated energy requirements. Patients with cognitive impairment or feeding dependency appeared to gain substantial benefit from mealtime assistance interventions. The increase in occasions of mealtime assistance by nursing staff during the intervention period was maintained six-months post-intervention. Staff focus groups highlighted the importance of clearly designating and defining mealtime responsibilities in order to provide adequate mealtime care. While the purpose of the dedicated feeding assistant was to increase levels of mealtime assistance, staff indicated that responsibility for mealtime duties may have merely shifted from nursing staff to the assistant. Implementing the multidisciplinary interventions empowered nursing staff to "protect" the mealtime from external interruptions, but further work is required to empower nurses to prioritise mealtime activities within their own work schedules. Staff reported an increase in the profile of nutritional care on all wards, with additional non-nutritional benefits noted including improved mobility and functional independence, and better identification of swallowing difficulties. IMPLICATIONS: The PhD research provides clinicians with practical strategies to immediately introduce change to deliver better mealtime care in the hospital setting, and, as such, has initiated local and state-wide roll-out of mealtime assistance programs. Improved nutritional intakes of elderly inpatients was observed; however given the modest effect size and reducing lengths of hospital stays, better nutritional outcomes may be achieved by targeting the hospital-to-home transition period. Findings from this study suggest that mealtime assistance interventions for elderly inpatients with cognitive impairment and/or functional dependency show promise.

State-of-the-art of the Australian thin bed concrete structural masonry

With a view to minimising the spiraling labour costs, the concrete masonry industry is developing thin layer mortar technology (known as thin bed technology) collaboratively with Queensland University of Technology. Similar technologies are practiced in Europe mainly for clay brick masonry; in the UK thin layer mortared concrete masonry has been researched under commercial contract with limited information published. This paper presents numerous experimental data generated over the past three years. It is shown that this form of masonry requires special drymixed mortar containing a minimum of 2% polymer for improved workability and blocks with tighter height tolerance, both of which might increase the cost of these constituent materials. However, through semiskilled labour, tools to dispense and control the thickness of mortar and the associated increase in productivity, reduction to the overall costs of this form of construction can be achieved. Further the polymer mortar provides several advantages: (1) improved sustainability due to dry curing and (2) potential to construct mortar layers of 2mm thickness and (3) ability for mechanisation of mortar application and control of thickness without the need for skilled labour.

Age and curing effect on the bond strength of thin bed concrete masonry with polymer cement mortar

Bond characteristics of masonry are partly affected by the type of mortar used, the techniques of dispersion of mortar and the surface texture of the concrete blocks. Additionally it is understood from the studies on conventional masonry, the bond characteristics are influenced by masonry age and curing methods as well as dryness/dampness at the time of testing. However, all these effects on bond for thin bed masonry containing polymer cement mortar are not well researched. Therefore, the effect of ageing and curing method on bond strength of masonry made with polymer cement mortar was experimentally investigated as part of an ongoing bond strength research program on thin bed concrete masonry at Queensland University of technology. This paper presents the experimental investigation of the flexural and shears bond characteristics of thin bed concrete masonry of varying age/ curing methods. Since, the polymer cement mortar is commonly used in thin bed masonry; bond development through two different curing conditions (dry/wet) was investigated in this research work. The results exhibit that the bond strength increases with the age under the wet and dry curing conditions; dry curing produce stronger bond and is considered as an advantage towards making this form of thin bed masonry better sustainable.

Developments in mud filtration technology in the sugarcane industry

Dirt collected with sugarcane is processed and separated from the juice in the sugar factory by filtration equipment for return to the cane fields. New technologies over the past decade have enabled performance improvements to be obtained for this key unit operation. Filter mud product still contains a reasonable amount of sugar and the transportation of high moisture mud product has considerable cost. Australia’s traditional approach has been to use Rotary Vacuum Filters for processing and separating mud and other impurities from juice, but in recent years there has been interest in reducing sugar losses and transportation costs through utilisation of new technologies such as Horizontal Bed Filters, Vacuum Belt Press Filters, Membrane Press Filters and Centrifuges. Increasingly, these alternative equipment are being installed in new factories. This chapter describes the general principles of mud filtration theory and mud conditioning followed by a detailed description and review of the various filtration technologies and analysis of the relative merits associated with the equipment.

Raman microscopy of formamide-intercalated kaolinites treated by controlled-rate thermal analysis technology

Raman spectroscopy of formamide-intercalated kaolinites treated using controlled-rate thermal analysis technology (CRTA), allowing the separation of adsorbed formamide from intercalated formamide in formamide-intercalated kaolinites, is reported. The Raman spectra of the CRTA-treated formamide-intercalated kaolinites are significantly different from those of the intercalated kaolinites, which display a combination of both intercalated and adsorbed formamide. An intense band is observed at 3629 cm-1, attributed to the inner surface hydroxyls hydrogen bonded to the formamide. Broad bands are observed at 3600 and 3639 cm-1, assigned to the inner surface hydroxyls, which are hydrogen bonded to the adsorbed water molecules. The hydroxyl-stretching band of the inner hydroxyl is observed at 3621 cm-1 in the Raman spectra of the CRTA-treated formamide-intercalated kaolinites. The results of thermal analysis show that the amount of intercalated formamide between the kaolinite layers is independent of the presence of water. Significant differences are observed in the CO stretching region between the adsorbed and intercalated formamide.