Secondary prevention of cardiovascular disease in different primary healthcare systems with and without pay-for-performance

Objective: To compare baseline cardiovascular risk management between people recruited from two different healthcare systems, to a research trial of an intervention to optimize secondary prevention. Design: Cross-sectional study. Setting: General practices, randomly selected: 16 in Northern Ireland (NI) (UK NHS, ‘strong’ infrastructure); 32 in Republic of Ireland (RoI) (mixed healthcare economy, less infrastructure). Patients: 903 (mean age 67.5 years; 69.9% male); randomly selected, known coronary heart disease. Main outcome measures: Blood pressure, cholesterol, medications; validated questionnaires for diet (DINE), exercise (Godin), quality of life (SF12); healthcare usage. Results: More RoI than NI participants had systolic BP>140 mmHg (37% v 28%, p=0.01) and cholesterol >5mmol/l (24% v 17%, p=0.02): RoI mean systolic BP was higher (139 v 132 mm Hg). More RoI participants reported a high fibre intake (35% v 23%), higher levels of physical activity (62% v 44%), and better physical and mental health (SF12); they had more GP (5.6 v 4.4) and fewer nurse visits (1.6 v 2.1) in the previous year. Fewer in RoI (55% v 70%) were prescribed B blockers. Both groups’ ACE inhibitor (41%; 48%) prescribing was similar; high proportions were prescribed statins (84%; 85%) and aspirin (83%; 77%). Conclusions Blood pressure and cholesterol are better controlled among patients in a primary healthcare system with a ‘strong’ infrastructure supporting computerization and rewarding measured performance but this is not associated with healthier lifestyle or better quality of life. Further exploration of differences in professionals’ and patients’ engagement in secondary prevention in different healthcare systems is needed.

Physical modelling of millimetre wave signal reflection from forward biased PIN diodes

This paper examines the DC power requirements of PIN diodes which, with suitable applied DC bias, have the potential to reflect or to permit transmission of millimetre wave energy through them by the process of inducing a semiconductor plasma layer in the i-region. The study is conducted using device level simulation of SOI and bulk PIN diodes and reflection modelling based on the Drude conduction model. We examined five diode lengths (60–140 µm) and seven diode thicknesses (4–100 µm). Simulation output for the diodes of varying thicknesses was subsequently used in reflection modelling to assess their performance for 100 GHz operation. It is shown that substantially high DC input power is required in order to induce near total reflection in SOI PIN diodes at 100 GHz. Thinner devices consume less DC power, but reflect less incident radiation for given input power. SOI diodes are shown to have improved carrier confinement compared with bulk diodes.

The settlement performance of stone column foundations

Vibrated stone columns are frequently used as a method of reinforcing soft ground as they provide increased bearing capacity and reduce foundation settlements. Their performance in relation to bearing capacity is well documented, but there is also a need for enhanced understanding of their settlement characteristics, particularly in relation to small-group configurations. This paper presents results obtained from physical model tests on triaxial specimens 300 mm in diameter and 400 mm high. Parameters investigated include column length to diameter ratio, area replacement ratio and single/group configuration. The findings of the work are as follows. The design is flexible: settlement can equally be controlled using short columns at relatively high area replacement ratios, or longer columns at smaller area replacement ratios. An optimum area replacement ratio of 30-40% exists for the control of settlement. The settlement performance of a small column group is highly influenced by inter-column and footing interaction effects.

Effect of temporal separation on synchronization in rhythmic performance

A variety of short time delays inserted between pairs of subjects were found to affect their ability to synchronize a musical task. The subjects performed a clapping rhythm together from separate sound-isolated rooms via headphones and without visual contact. One-way time delays between pairs were manipulated electronically in the range of 3 to 78 ms. We are interested in quantifying the envelope of time delay within which two individuals produce synchronous per- formances. The results indicate that there are distinct regimes of mutually coupled behavior, and that `natural time delay'o¨delay within the narrow range associated with travel times across spatial arrangements of groups and ensembleso¨supports the most stable performance. Conditions outside of this envelope, with time delays both below and above it, create characteristic interaction dynamics in the mutually coupled actions of the duo. Trials at extremely short delays (corresponding to unnaturally close proximity) had a tendency to accelerate from anticipation. Synchronization lagged at longer delays (larger than usual physical distances) and produced an increasingly severe deceleration and then deterioration of performed rhythms. The study has implications for music collaboration over the Internet and suggests that stable rhythmic performance can be achieved by `wired ensembles' across distances of thousands of kilometers.

The effects of temperature on the performance of electrochemical double layer capacitors

An electrochemical double layer capacitor test cell containing activated carbon xerogel electrodes and ionic liquid electrolyte was tested at 15, 25 and 40 OC to examine the effect of temperature on electrolyte resistance (RS) and equivalent series resistance (ESR) measured using impedance spectroscopy and capacitance using charge/discharge cycling. A commercial 10F capacitor was used as a comparison. Viscosity, ionic self-diffusion coefficients and differential scanning calorimetry measurements were used to provide an insight into the behaviour of the 1,2-dimethyl-3-propylimdazolium electrolyte. Both RS and ESR decreased with increasing temperature for both capacitors. Increasing the temperature also increased the capacitance for both the test cell and the commercial capacitor but proportionally more for the test cell. An increase in temperature decreased the ionic liquid electrolyte viscosity and increased the self diffusion coefficients of both the anion and the cation indicating an increase in dissociation and increase in ionic mobility.

Mesoporous SSZ-13 zeolite prepared by a dual-template method with improved performance in the methanol-to-olefins reaction

Hierarchical SSZ-13 zeolites were synthesized by combining N,N,N-trimethyl-1-adamantanammonium hydroxide (TMAdOH) as the structure-directing agent for chabazite formation with mono- and diquaternary ammonium-type and organosilane mesoporogens and extensively characterized for their structural, textural, and catalytic properties. Mesoporous SSZ-13 zeolites can be synthesized in one step by combining TMAdOH and the diquaternary ammonium-type surfactant C22-4-4Br2. The mesopore volume increases with the mesoporogen/SDA ratio. The hierarchical zeolites are highly crystalline and exhibit similar Brønsted acidity as SSZ-13. Hierarchical SSZ-13 zeolites display increased lifetime in packed-bed MTO experiments than conventional SSZ-13 at similar light olefins yield. The increased lifetime is due to better utilization of the micropore space. With increasing mesoporosity, the micropore space is used more efficiently, but also the rate of coke formation at the crystal periphery increases. Accordingly, the most stable zeolite is obtained at a relatively low C22-4-4Br2/SDA ratio. These zeolite catalysts can be regenerated without substantial loss of activity.

Performance of density functionals for calculating barrier heights of chemical reactions relevant to astrophysics

The performance of 39 different LDA, GGA, meta-GGA, and hybrid density functionals has been evaluated, for calculating forward and reverse barrier heights of 10 gas-phase reactions involving hydrogen. The reactions are all relevant to astrochemistry. Special focus is put on the applicability of DFT for calculating the rates of corresponding surface hydrogenation reactions that are relevant to the chemistry of ice-coated interstellar grains. General trends in the performance of the density functionals for reactions involving H atoms, H-2, and OH are discussed. The OH+CO reaction is shown to be a very problematic case for DFT. The best overall performance is found for the hybrid density functionals, such as MPW1K, B97-1, B97-2, and B1B95. For several reactions, the HCTH GGA functionals and the VS98 and OLAP3 meta-GGA functionals also give results that are almost as good as those of the hybrid functionals.

Effect of increased fruit and vegetable consumption on physical function and muscle strength in older adults

Fruit and vegetable (FV) intake, which is often low in older people, may be associated with improved muscle strength and physical function. However, there is a shortage of intervention trial evidence to support this. The current study examined the effect of increased FV consumption on measures of muscle strength and physical function among healthy, free-living older adults. A randomized controlled intervention study was undertaken. Eighty-three participants aged 65-85 years, habitually consuming =2 portions of FV/day, were randomised to continue their normal diet (=2 portions/day), or to consume =5 portions of FV/day for 16 weeks. FV were delivered to all participants each week, free of charge. Compliance was monitored at baseline, 6, 12 and 16 weeks by diet history and by measuring biomarkers of micronutrient status. Grip strength was measured by a hand-held dynamometer, while lower-extremity physical function was assessed by performance-based measures. Eighty-two participants completed the intervention. The 5 portions/day group showed greater change in daily FV consumption compared to the 2 portions/day group (P?

Performance of Nonlocal Optics When Applied to Plasmonic Nanostructures

Semiclassical nonlocal optics based on the hydrodynamic description of conduction electrons might be an adequate tool to study complex phenomena in the emerging field of nanoplasmonics. With the aim of confirming this idea, we obtain the local and nonlocal optical absorption spectra in a model nanoplasmonic device in which there are spatial gaps between the components at nanometric and subnanometric scales. After a comparison against time-dependent density functional calculations, we conclude that hydrodynamic nonlocal optics provides absorption spectra exhibiting qualitative agreement but not quantitative accuracy. This lack of accuracy, which is manifest even in the limit where induced electric currents are not established between the constituents of the device, is mainly due to the poor description of induced electron densities.

A new look at dual-hop relaying: Performance limits with hardware impairments

Physical transceivers have hardware impairments that create distortions which degrade the performance of communication systems. The vast majority of technical contributions in the area of relaying neglect hardware impairments and, thus, assume ideal hardware. Such approximations make sense in low-rate systems, but can lead to very misleading results when analyzing future high-rate systems. This paper quantifies the impact of hardware impairments on dual-hop relaying, for both amplify-and-forward and decode-and-forward protocols. The outage probability (OP) in these practical scenarios is a function of the effective end-to-end signal-to-noise-and-distortion ratio (SNDR). This paper derives new closed-form expressions for the exact and asymptotic OPs, accounting for hardware impairments at the source, relay, and destination. A similar analysis for the ergodic capacity is also pursued, resulting in new upper bounds. We assume that both hops are subject to independent but non-identically distributed Nakagami-m fading. This paper validates that the performance loss is small at low rates, but otherwise can be very substantial. In particular, it is proved that for high signal-to-noise ratio (SNR), the end-to-end SNDR converges to a deterministic constant, coined the SNDR ceiling, which is inversely proportional to the level of impairments. This stands in contrast to the ideal hardware case in which the end-to-end SNDR grows without bound in the high-SNR regime. Finally, we provide fundamental design guidelines for selecting hardware that satisfies the requirements of a practical relaying system.

Establishing Metrics for Assessing the Performance of Directional Modulation Systems

In this paper metrics for assessing the performance of directional modulation (DM) physical-layer secure wireless systems are discussed. In the paper DM systems are shown to be categorized as static or dynamic. The behavior of each type of system is discussed for QPSK modulation. Besides EVM-like and BER metrics, secrecy rate as used in information theory community is also derived for the purpose of this QPSK DM system evaluation.

Physical and electrochemical evaluation of ATO supported IrO2 catalyst for proton exchange membrane water electrolyser

Antimony doped tin oxide (ATO) was studied as a support material for IrO₂ in proton exchange membrane water electrolyser (PEMWE). Adams fusion method was used to prepare the IrO₂-ATO catalysts. The physical and electrochemical characterisation of the catalysts were carried out using X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), powder conductivity, cyclic voltammetry (CV) and membrane electrode assembly (MEA) polarisation. The BET surface area and electronic conductivity of the supported catalysts were found to be predominantly arisen from the IrO₂. Supported catalyst showed higher active surface area than the pristine IrO₂ in CV analysis with 85% H₃PO₄ as electrolyte. The MEA performance using Nafion®−115 membrane at 80 °C and atmospheric pressure showed a better performance for IrO₂ loading ≥60 wt.% than the pristine IrO₂ with a normalised current density of 1625 mA cm⁻² @1.8 V for the 60% IrO₂-ATO compared to 1341 mA cm⁻² for the pristine IrO₂ under the same condition. The higher performance of the supported catalysts was mainly attributed to better dispersion of active IrO₂ on electrochemically inactive ATO support material, forming smaller IrO₂ crystallites. A 40 wt.% reduction in the IrO₂ was achieved by utilising the support material.

Compositional and Performance Mapping in Computer Chamber Music: A Case Study

The mapping problem is inherent to digital musical instruments (DMIs), which require, at the very least, an association between physical gestures and digital synthesis algorithms to transform human bodily performance into sound. This article considers the DMI mapping problem in the context of the creation and performance of a heterogeneous computer chamber music piece, a trio for violin, biosensors, and computer. Our discussion situates the DMI mapping problem within the broader set of interdependent musical interaction issues that surfaced during the composition and rehearsal of the trio. Through descriptions of the development of the piece, development of the hardware and software interfaces, lessons learned through rehearsal, and self-reporting by the participants, the rich musical possibilities and technical challenges of the integration of digital musical instruments into computer chamber music are demonstrated.

Sedentary behaviour and physical activity in bronchiectasis: a cross-sectional study

BACKGROUND: The impact of bronchiectasis on sedentary behaviour and physical activity is unknown. It is important to explore this to identify the need for physical activity interventions and how to tailor interventions to this patient population. We aimed to explore the patterns and correlates of sedentary behaviour and physical activity in bronchiectasis.

METHODS: Physical activity was assessed in 63 patients with bronchiectasis using an ActiGraph GT3X+ accelerometer over seven days. Patients completed: questionnaires on health-related quality-of-life and attitudes to physical activity (questions based on an adaption of the transtheoretical model (TTM) of behaviour change); spirometry; and the modified shuttle test (MST). Multiple linear regression analysis using forward selection based on likelihood ratio statistics explored the correlates of sedentary behaviour and physical activity dimensions. Between-group analysis using independent sample t-tests were used to explore differences for selected variables.

RESULTS: Fifty-five patients had complete datasets. Average daily time, mean(standard deviation) spent in sedentary behaviour was 634(77)mins, light-lifestyle physical activity was 207(63)mins and moderate-vigorous physical activity (MVPA) was 25(20)mins. Only 11% of patients met recommended guidelines. Forced expiratory volume in one-second percentage predicted (FEV1% predicted) and disease severity were not correlates of sedentary behaviour or physical activity. For sedentary behaviour, decisional balance 'pros' score was the only correlate. Performance on the MST was the strongest correlate of physical activity. In addition to the MST, there were other important correlate variables for MVPA accumulated in ≥10-minute bouts (QOL-B Social Functioning) and for activity energy expenditure (Body Mass Index and QOL-B Respiratory Symptoms).

CONCLUSIONS: Patients with bronchiectasis demonstrated a largely inactive lifestyle and few met the recommended physical activity guidelines. Exercise capacity was the strongest correlate of physical activity, and dimensions of the QOL-B were also important. FEV1% predicted and disease severity were not correlates of sedentary behaviour or physical activity. The inclusion of a range of physical activity dimensions could facilitate in-depth exploration of patterns of physical activity. This study demonstrates the need for interventions targeted at reducing sedentary behaviour and increasing physical activity, and provides information to tailor interventions to the bronchiectasis population.