Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses

OBJECTIVES: To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. DESIGN: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. DATA SOURCES: Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005. RESULTS: 1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment. CONCLUSION: There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.

Technique for micro-machining millimetre-wave rectangular waveguide

A new technique is reported for micro-machining millimetre-wave rectangular waveguide components. S-parameter measurements on these structures show that they achieve lower loss than those produced using any other on-chip fabrication technique, have highly accurate dimensions, are physically robust, and are cheap and easy to manufacture.

A study of the antioxidant capacity of oak wood used in wine ageing and the correlation with polyphenol composition

The antioxidant capacity of oak wood used in the ageing of wine was studied by four different methods: measurement of scavenging capacity against a given radical (ABTS, DPPH), oxygen radical absorbance capacity (ORAC) and the ferric reducing antioxidant power (FRAP). Although, the four methods tested gave comparable results for the antioxidant capacity measured in oak wood extracts, the ORAC method gave results with some differences from the other methods. Non-toasted oak wood samples displayed more antioxidant power than toasted ones due to differences in the polyphenol compositon. A correlation analysis revealed that ellagitannins were the compounds mainly responsible for the antioxidant capacity of oak wood. Some phenolic acids, mainly gallic acid, also showed a significant correlation with antioxidant capacity.

Benchmark datasets for detection and tracking

There is a rising demand for the quantitative performance evaluation of automated video surveillance. To advance research in this area, it is essential that comparisons in detection and tracking approaches may be drawn and improvements in existing methods can be measured. There are a number of challenges related to the proper evaluation of motion segmentation, tracking, event recognition, and other components of a video surveillance system that are unique to the video surveillance community. These include the volume of data that must be evaluated, the difficulty in obtaining ground truth data, the definition of appropriate metrics, and achieving meaningful comparison of diverse systems. This chapter provides descriptions of useful benchmark datasets and their availability to the computer vision community. It outlines some ground truth and evaluation techniques, and provides links to useful resources. It concludes by discussing the future direction for benchmark datasets and their associated processes.

Communication and social regulation. the criminalization of work-related death

This paper addresses the movement towards criminalization as a tool for the regulation of work-related deaths in the United Kingdom and elsewhere in the last 20 years. This can be seen as reflecting dissatisfaction with the relevant law, although it is best understood in symbolic terms as a response to a disjunction between the instrumental nature and communicative aspirations of regulatory law. This paper uses empirical data gathered from interviews with members of the public to explore the role that such an offence might play. The findings demonstrate that the failures of regulatory law give rise to a desire for criminalization as a means of framing work-related safety events in normative terms.

Endothelin-converting enzyme-1 regulates endosomal sorting of calcitonin receptor-like receptor and beta-arrestins

Although cell surface metalloendopeptidases degrade neuropeptides in the extracellular fluid to terminate signaling, the function of peptidases in endosomes is unclear. We report that isoforms of endothelin-converting enzyme-1 (ECE-1a-d) are present in early endosomes, where they degrade neuropeptides and regulate post-endocytic sorting of receptors. Calcitonin gene-related peptide (CGRP) co-internalizes with calcitonin receptor-like receptor (CLR), receptor activity-modifying protein 1 (RAMP1), beta-arrestin2, and ECE-1 to early endosomes, where ECE-1 degrades CGRP. CGRP degradation promotes CLR/RAMP1 recycling and beta-arrestin2 redistribution to the cytosol. ECE-1 inhibition or knockdown traps CLR/RAMP1 and beta-arrestin2 in endosomes and inhibits CLR/RAMP1 recycling and resensitization, whereas ECE-1 overexpression has the opposite effect. ECE-1 does not regulate either the resensitization of receptors for peptides that are not ECE-1 substrates (e.g., angiotensin II), or the recycling of the bradykinin B(2) receptor, which transiently interacts with beta-arrestins. We propose a mechanism by which endosomal ECE-1 degrades neuropeptides in endosomes to disrupt the peptide/receptor/beta-arrestin complex, freeing internalized receptors from beta-arrestins and promoting recycling and resensitization.

Trade-offs and responsiveness of the single-layer urban canopy parametrization in WRF: an offline evaluation using the MOSCEM optimization algorithm and field observations

For an increasing number of applications, mesoscale modelling systems now aim to better represent urban areas. The complexity of processes resolved by urban parametrization schemes varies with the application. The concept of fitness-for-purpose is therefore critical for both the choice of parametrizations and the way in which the scheme should be evaluated. A systematic and objective model response analysis procedure (Multiobjective Shuffled Complex Evolution Metropolis (MOSCEM) algorithm) is used to assess the fitness of the single-layer urban canopy parametrization implemented in the Weather Research and Forecasting (WRF) model. The scheme is evaluated regarding its ability to simulate observed surface energy fluxes and the sensitivity to input parameters. Recent amendments are described, focussing on features which improve its applicability to numerical weather prediction, such as a reduced and physically more meaningful list of input parameters. The study shows a high sensitivity of the scheme to parameters characterizing roof properties in contrast to a low response to road-related ones. Problems in partitioning of energy between turbulent sensible and latent heat fluxes are also emphasized. Some initial guidelines to prioritize efforts to obtain urban land-cover class characteristics in WRF are provided. Copyright © 2010 Royal Meteorological Society and Crown Copyright.

A Brassica exon array for whole-transcript gene expression profiling

Affymetrix GeneChip (R) arrays are used widely to study transcriptional changes in response to developmental and environmental stimuli. GeneChip (R) arrays comprise multiple 25-mer oligonucleotide probes per gene and retain certain advantages over direct sequencing. For plants, there are several public GeneChip (R) arrays whose probes are localised primarily in 39 exons. Plant whole-transcript (WT) GeneChip (R) arrays are not yet publicly available, although WT resolution is needed to study complex crop genomes such as Brassica, which are typified by segmental duplications containing paralogous genes and/or allopolyploidy. Available sequence data were sampled from the Brassica A and C genomes, and 142,997 gene models identified. The assembled gene models were then used to establish a comprehensive public WT exon array for transcriptomics studies. The Affymetrix GeneChip (R) Brassica Exon 1.0 ST Array is a 5 mu M feature size array, containing 2.4 million 25-base oligonucleotide probes representing 135,201 gene models, with 15 probes per gene distributed among exons. Discrimination of the gene models was based on an E-value cut-off of 1E(-5), with <= 98 sequence identity. The 135 k Brassica Exon Array was validated by quantifying transcriptome differences between leaf and root tissue from a reference Brassica rapa line (R-o-18), and categorisation by Gene Ontologies (GO) based on gene orthology with Arabidopsis thaliana. Technical validation involved comparison of the exon array with a 60-mer array platform using the same starting RNA samples. The 135 k Brassica Exon Array is a robust platform. All data relating to the array design and probe identities are available in the public domain and are curated within the BrassEnsembl genome viewer at http://www.brassica.info/BrassEnsembl/index.html.

Hurricanes and climate: the U.S. CLIVAR working group on hurricanes

While a quantitative climate theory of tropical cyclone formation remains elusive, considerable progress has been made recently in our ability to simulate tropical cyclone climatologies and understand the relationship between climate and tropical cyclone formation. Climate models are now able to simulate a realistic rate of global tropical cyclone formation, although simulation of the Atlantic tropical cyclone climatology remains challenging unless horizontal resolutions finer than 50 km are employed. This article summarizes published research from the idealized experiments of the Hurricane Working Group of U.S. CLIVAR (CLImate VARiability and predictability of the ocean-atmosphere system). This work, combined with results from other model simulations, has strengthened relationships between tropical cyclone formation rates and climate variables such as mid-tropospheric vertical velocity, with decreased climatological vertical velocities leading to decreased tropical cyclone formation. Systematic differences are shown between experiments in which only sea surface temperature is increased versus experiments where only atmospheric carbon dioxide is increased, with the carbon dioxide experiments more likely to demonstrate the decrease in tropical cyclone numbers previously shown to be a common response of climate models in a warmer climate. Experiments where the two effects are combined also show decreases in numbers, but these tend to be less for models that demonstrate a strong tropical cyclone response to increased sea surface temperatures. Further experiments are proposed that may improve our understanding of the relationship between climate and tropical cyclone formation, including experiments with two-way interaction between the ocean and the atmosphere and variations in atmospheric aerosols.

Energy and pitch-angle dispersions of LLBL/cusp ions seen at middle altitudes: predictions by the open magnetosphere model

Numerical simulations are presented of the ion distribution functions seen by middle-altitude spacecraft in the low-latitude boundary layer (LLBL) and cusp regions when reconnection is, or has recently been, taking place at the equatorial magnetopause. From the evolution of the distribution function with time elapsed since the field line was opened, both the observed energy/observation-time and pitch-angle/energy dispersions are well reproduced. Distribution functions showing a mixture of magnetosheath and magnetospheric ions, often thought to be a signature of the LLBL, are found on newly opened field lines as a natural consequence of the magnetopause effects on the ions and their flight times. In addition, it is shown that the extent of the source region of the magnetosheath ions that are detected by a satellite is a function of the sensitivity of the ion instrument . If the instrument one-count level is high (and/or solar-wind densities are low), the cusp ion precipitation detected comes from a localised region of the mid-latitude magnetopause (around the magnetic cusp), even though the reconnection takes place at the equatorial magnetopause. However, if the instrument sensitivity is high enough, then ions injected from a large segment of the dayside magnetosphere (in the relevant hemisphere) will be detected in the cusp. Ion precipitation classed as LLBL is shown to arise from the low-latitude magnetopause, irrespective of the instrument sensitivity. Adoption of threshold flux definitions has the same effect as instrument sensitivity in artificially restricting the apparent source region.

Ionospheric and geomagnetic responses to changes in IMF B_Z: a superposed epoch study

Superposed epoch studies have been carried out in order to determine the ionospheric response at mid-latitudes to southward turnings of the interplanetary magnetic field (IMF). This is compared with the geomagnetic response, as seen in the indices K p, AE and Dst. The solar wind, IMF and geomagnetic data used were hourly averages from the years 1967–1989 and thus cover a full 22-year cycle in the solar magnetic field. These data were divided into subsets, determined by the magnitudes of the southward turnings and the concomitant increase in solar wind pressure. The superposed epoch studies were carried out using the time of the southward turning as time zero. The response of the mid-latitude ionosphere is studied by looking at the F-layer critical frequencies, f o F2, from hourly soundings by the Slough ionosonde and their deviation from the monthly median values, δf o F2. For the southward turnings with a change in B z of δB z > 11.5 nT accompanied by a solar wind dynamic pressure P exceeding 5 nPa, the F region critical frequency, f o F2, shows a marked decrease, reaching a minimum value about 20 h after the southward turning. This recovers to pre-event values over the subsequent 24 h, on average. The Dst index shows the classic storm-time decrease to about −60 nT. Four days later, the index has still to fully recover and is at about −25 nT. Both the K p and AE indices show rises before the southward turnings, when the IMF is strongly northward but the solar wind dynamic pressure is enhanced. The average AE index does register a clear isolated pulse (averaging 650 nT for 2 h, compared with a background peak level of near 450 nT at these times) showing enhanced energy deposition at high latitudes in substorms but, like K p, remains somewhat enhanced for several days, even after the average IMF has returned to zero after 1 day. This AE background decays away over several days as the Dst index recovers, indicating that there is some contamination of the currents observed at the AE stations by the continuing enhanced equatorial ring current. For data averaged over all seasons, the critical frequencies are depressed at Slough by 1.3 MHz, which is close to the lower decile of the overall distribution of δf o Fl values. Taking 30-day periods around summer and winter solstice, the largest depression is 1.6 and 1.2 MHz, respectively. This seasonal dependence is confirmed by a similar study for a Southern Hemisphere station, Argentine Island, giving peak depressions of 1.8 MHz and 0.5 MHz for summer and winter. For the subset of turnings where δB z > 11.5 nT and P ≤ 5 nPa, the response of the geomagnetic indices is similar but smaller, while the change in δf o F2 has all but disappeared. This confirms that the energy deposited at high latitudes, which leads to the geomagnetic and ionospheric disturbances following a southward turning of the IMF, increases with the energy density (dynamic pressure) of the solar wind flow. The magnitude of all responses are shown to depend on δB z . At Slough, the peak depression always occurs when Slough rotates into the noon sector. The largest ionospheric response is for southward turnings seen between 15–21 UT.