Assessing Lifetime Homes Standards and Part M Building Regulations for Housing Design in the UK

The aims of this article are to examine Lifetime Home Standards (LTHS) and Part M of the UK Building Regulations and to discuss how relevant and successful they are. The UK government expects all new homes to be built to LTHS by 2013. This is increasingly important with an ageing population. The home environment can enable independence and provide a therapeutic place for everyone. As Part M of the building regulations are compulsory in all housing and LTHS are mandatory for public sector housing, a review of research articles was undertaken on these standards. The paper begins with a brief background on accessibility regulations, followed by a critical review of the standards that takes the body of literature that has been written around them into account. This review suggests that the standards should be improved and that designers and architects face challenges to creatively incorporate them into housing design.

Keratinocyte growth factor in acute lung injury to reduce pulmonary dysfunction--a randomised placebo-controlled trial (KARE):study protocol

Acute lung injury is a common, devastating clinical syndrome associated with substantial mortality and morbidity with currently no proven therapeutic interventional strategy to improve patient outcomes. The objectives of this study are to test the potential therapeutic effects of keratinocyte growth factor for patients with acute lung injury on oxygenation and biological indicators of acute inflammation, lung epithelial and endothelial function, protease:antiprotease balance, and lung extracellular matrix degradation and turnover.

Simvastatin in the Acute Respiratory Distress Syndrome

Background

Studies in animals and in vitro and phase 2 studies in humans suggest that statins may be beneficial in the treatment of the acute respiratory distress syndrome (ARDS). This study tested the hypothesis that treatment with simvastatin would improve clinical outcomes in patients with ARDS.

Methods

In this multicenter, double-blind clinical trial, we randomly assigned (in a 1:1 ratio) patients with an onset of ARDS within the previous 48 hours to receive enteral simvastatin at a dose of 80 mg or placebo once daily for a maximum of 28 days. The primary outcome was the number of ventilator-free days to day 28. Secondary outcomes included the number of days free of nonpulmonary organ failure to day 28, mortality at 28 days, and safety.

Results

The study recruited 540 patients, with 259 patients assigned to simvastatin and 281 to placebo. The groups were well matched with respect to demographic and baseline physiological variables. There was no significant difference between the study groups in the mean (±SD) number of ventilator-free days (12.6±9.9 with simvastatin and 11.5±10.4 with placebo, P=0.21) or days free of nonpulmonary organ failure (19.4±11.1 and 17.8±11.7, respectively; P=0.11) or in mortality at 28 days (22.0% and 26.8%, respectively; P=0.23). There was no significant difference between the two groups in the incidence of serious adverse events related to the study drug.

Conclusions

Simvastatin therapy, although safe and associated with minimal adverse effects, did not improve clinical outcomes in patients with ARDS. (Funded by the U.K. National Institute for Health Research Efficacy and Mechanism Evaluation Programme and others; HARP-2 Current Controlled Trials number, ISRCTN88244364.)

Meeting the needs of visually impaired people living in Lifetime Homes

This article explores perceptions on the suitability and effectiveness of Lifetime Homes Standards (LTHS) for those with visual impairment in Northern Ireland.
LTHS are a series of mandatory United Kingdom (UK) public sector housing design interventions, providing a model for ensuring accessible and adaptable homes throughout an occupant's lifespan. An ageing demographic with increasing incidence of diabetes, has led to rising numbers of elderly visually impaired people wanting to remain in their homes for longer.
Qualitative semi structured interviews were conducted with thirteen key stakeholders and thematically analysed. Although findings show that employing LTHS offers benefits to visually impaired residents, short-comings were also identified. Evidence indicates a need for Policy Makers, Health Care Professionals and Housing Associations to modify practices to better meet the housing needs of visually impaired people. Findings may also be applicable to those with other impairments and disabilities in relation to housing for elderly residents.

Evaluating early administration of the hydroxymethylglutaryl-CoA reductase inhibitor simvastatin in the prevention and treatment of delirium in critically ill ventilated patients (MoDUS trial): Study protocol for a randomized controlled trial

Background: The incidence of delirium in ventilated patients is estimated at up to 82%, and it is associated with longer intensive care and hospital stays, and long-term cognitive impairment and mortality. The pathophysiology of delirium has been linked with inflammation and neuronal apoptosis. Simvastatin has pleiotropic properties; it penetrates the brain and, as well as reducing cholesterol, reduces inflammation when used at clinically relevant doses over the short term. This is a single centre randomised, controlled trial which aims to test the hypothesis that treatment with simvastatin will modify delirium incidence and outcomes. 

Methods/Design: The ongoing study will include 142 adults admitted to the Watford General Hospital Intensive Care Unit who require mechanical ventilation in the first 72 hours of admission. The primary outcome is the number of delirium- and coma-free days in the first 14 days. Secondary outcomes include incidence of delirium, delirium- and coma-free days in the first 28 days, days in delirium and in coma at 14 and 28 days, number of ventilator-free days at 28 days, length of critical care and hospital stay, mortality, cognitive decline and healthcare resource use. Informed consent will be taken from patient's consultee before randomisation to receive either simvastatin (80 mg) or placebo once daily. Daily data will be recorded until day 28 after randomisation or until discharge from the ICU if sooner. Surviving patients will be followed up on at six months from discharge. Plasma and urine samples will be taken to investigate the biological effect of simvastatin on systemic markers of inflammation, as related to the number of delirium- and coma-free days, and the potential of cholinesterase activity and beta-amyloid as predictors of the risk of delirium and long-term cognitive impairment. 

Discussion: This trial will test the efficacy of simvastatin on reducing delirium in the critically ill. If patients receiving the statin show a reduced number of days in delirium compared with the placebo group, the inflammatory theory implicated in the pathogenesis of delirium will be strengthened. 

PAlliative Care in chronic Kidney diSease: the PACKS study—quality of life, decision making, costs and impact on carers in people managed without dialysis

BACKGROUND: The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK.

METHODS: In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to 'opt-in' with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists.

DISCUSSION: The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

Finding a way: Long term care homes to support dementia

An ageing demographic has increased the number of people with dementia. Although dementia is commonly associated with memory loss, other early symptoms include difficulty with wayfinding. Dementia alters visuo-spatial perception and the processes used to interpret the physical environment. The role of the design of the physical environment for people with dementia has gained increased recognition. Despite this, design for dementia is often overlooked, focusing on issues relating to physical impairment. This paper presents the results of a PhD study and aims to examine the role of the design of the physical environment in supporting wayfinding for people with dementia living in long-term care settings in Northern Ireland. Mixed methods combined the observation of wayfinding walks and conversational style interviews to elicit perspectives and experiences of residents with dementia. The findings aim to promote well-being for those with dementia living in long-term care settings.

Protocol for a pilot randomised controlled trial of an intervention to increase the use of traffic light food labelling in UK shoppers (the FLICC trial)

Background: Traffic light labelling of foods—a system that incorporates a colour-coded assessment of the level of total fat, saturated fat, sugar and salt on the front of packaged foods—has been recommended by the UK Government and is currently in use or being phased in by many UK manufacturers and retailers. This paper describes a protocol for a pilot randomised controlled trial of an intervention designed to increase the use of traffic light labelling during real-life food purchase decisions.

Methods/design: The objectives of this two-arm randomised controlled pilot trial are to assess recruitment, retention and data completion rates, to generate potential effect size estimates to inform sample size calculations for the main trial and to assess the feasibility of conducting such a trial. Participants will be recruited by email from a loyalty card database of a UK supermarket chain. Eligible participants will be over 18 and regular shoppers who frequently purchase ready meals or pizzas. The intervention is informed by a review of previous interventions encouraging the use of nutrition labelling and the broader behaviour change literature. It is designed to impact on mechanisms affecting belief and behavioural intention formation as well as those associated with planning and goal setting and the adoption and maintenance of the behaviour of interest, namely traffic light label use during purchases of ready meals and pizzas. Data will be collected using electronic sales data via supermarket loyalty cards and web-based questionnaires and will be used to estimate the effect of the intervention on the nutrition profile of purchased ready meals and pizzas and the behavioural mechanisms associated with label use. Data collection will take place over 48 weeks. A process evaluation including semi-structured interviews and web analytics will be conducted to assess feasibility of a full trial.

Discussion: The design of the pilot trial allows for efficient recruitment and data collection. The intervention could be generalised to a wider population if shown to be feasible in the main trial.

Chroniques françaises, Histoire d'Alexandre, etc.

Contient : Chronique de Normandie, depuis le duc Aubert jusqu'à Henri III, roi d'Angleterre ; Chronique française abrégée de GUILLAUME DE NANGIS, jusqu'à Philippe le Bel ; Chronologie des rois de France jusqu'à Charles VI ; suivie de notes latines : « De Anglia » (fol. 111) ; — « Le serment que le Chancelier de France doit faire, » etc. (fol. 112) ; Chronique des quatre premiers Valois (1327-1393), publiée par S. Luce (Paris, 1862, In 8°) ; Histoire d'Alexandre le Grand (Historia de præliis du Pseudo-Callisthènes), en français ; « Le livre des meurs du gouvernement des seigneurs, appelé les Secrés des secrés d'ARISTOTE » ; « Proposicion faicte de par l'Université de Paris devant nos seigneurs de France et tout le conseil assemblez pour la reformacion du royaume, l'an 1405, le samedi VIIe jour de novembre, par Me Jehan Jarson..., chancellier en l'eglise Nostre-Dame de Paris » ; Recueil de pièces concernant la Normandie. — « Carta Normannorum. » (19 mars 1314 [1315]) ; Vidimus du texte latin du traité de Troyes entre Henri V et Charles VI (21 mai 1420) ; « Pour remonstrer en brief que les habitans du duchié de Normandie et mesmement les bourgois, manans et habitans de la ville de Rouen, ne doivent estre trais en France, ne sont tenus de y sortir jur[i]diction ne y respondre... » — « Raciones précédentes fuerunt composite per mag. Johannem Doule, licenciatum In legibus, condam advocatum In parlamento et magistrum requestarum regis dominum de Neufville » ; Texte français du traité de Troyes (21 mai 1420) ; « Arrest ou declaraciun que ung prelat ou eglise peult acquérir en ses liefs », en faveur de l'abaye de St-Ouen de Rouen (1373 et 1375), etc ; « Confirmatio Cartæ Normannorum » (16 nov. 1423) ; « Decretum unionis orientalis Ecclesiæ cum occidentali, publicalum... In concilio Florentino... 1439 » ; « Copia bulle [Eugenii IV] conservatorie studii Cadomensis » (18 mai 1439) ; Au bas de ce feuillet on lit cette note, de première main : « Cronicas Normannie et Francie, ceterasque alias scripturassuperius scriptas varias materias continentes scribi fecit Robertus, abbas Sancti Michaelis In periculo maris, apud Rothomagum, In pluribus annis, et finaliter perfecit usque hic, anno Domini 1436 » ; Ex-libris : « Messire Joachin de Dinteville, chevalier de l'ordre du Roy et gentilhomme de sa chambre, m'a donné ce livre à Troyes, en febvrier 1578. » (Signature grattée)

A Validated Methodology for Genetic Identification of Tuna Species (Genus Thunnus)

Tuna species of the genus Thunnus, such as the bluefin tunas, are some of the most important and yet most endangered trade fish in the world. Identification of these species in traded forms, however, may be difficult depending on the presentation of the products, which may hamper conservation efforts on trade control. In this paper, we validated a genetic methodology that can fully distinguish between the eight Thunnus species from any kind of processed tissue. Methodology: After testing several genetic markers, a complete discrimination of the eight tuna species was achieved using Forensically Informative Nucleotide Sequencing based primarily on the sequence variability of the hypervariable genetic marker mitochondrial DNA control region (mtDNA CR), followed, in some specific cases, by a second validation by a nuclear marker rDNA first internal transcribed spacer (ITS1). This methodology was able to distinguish all tuna species, including those belonging to the subgenus Neothunnus that are very closely related, and in consequence can not be differentiated with other genetic markers of lower variability. This methodology also took into consideration the presence of introgression that has been reported in past studies between T. thynnus, T. orientalis and T. alalunga. Finally, we applied the methodology to cross-check the species identity of 26 processed tuna samples. Conclusions: Using the combination of two genetic markers, one mitochondrial and another nuclear, allows a full discrimination between all eight tuna species. Unexpectedly, the genetic marker traditionally used for DNA barcoding, cytochrome oxidase 1, could not differentiate all species, thus its use as a genetic marker for tuna species identification is questioned

Grasshoppers and crickets (Insecta : Orthoptera) from the lower cretaceous of southern England

This is a synoptic monograph of fossil Orthoptera from the English Lower Cretaceous (Purbeck and Wealden groups). The previously described taxa of these insects are revised on the basis of type specimens and examination of extensive new material. Eight new genera and 30 new species are proposed: Probaisselcana cretacea sp. nov., Minelcana membranacea gen. et sp. nov., Panorpidium proximum sp. nov., P. bimacillatum sp. nov., ?P. parvum sp. nov. (Elcanidae); ?Cyrtophyllites cretaceus sp. nov. (Haglidae); Aenigmodus minutus gen. et sp. nov., Pseudaboilus wealdensis gen. et sp. nov., P. purbeckensis sp. nov., Tettigoilus sonorus gen. et sp. nov., ?Agrionidium obscurum sp. nov. (Prophalangopsidae); Notocearagryllus britannicus sp. nov., N. grandispeculum sp. nov., N. cordispeculum sp. nov., Anglogryllus lyristes gen. et sp. nov., A. rotundispeculum sp. nov.. Speculogryllus acutispeculum gen. et sp. nov., Sharategia davisi sp. nov., S. batchelorae sp. nov., S. baldocki sp. nov. (Baissogryllidae); ?Araripegryllus orientalis sp. nov. (Gryllidae); Deinovitimia occidentalis sp. nov. (Ensifera: infraorder incertae sedis); Cretoxya rasnitsyni gen. et sp. nov. (Tridactylidae); Locustopsis posterior sp. nov., Zeunerella prior sp. nov., Zessinia borealis sp. nov., Mesolocustopsis anglica sp. nov., M. angusta sp. nov., M. problematica sp. nov., and Britannacrida distincta gen. et sp. nov (Locustopsidae). The subfamily Baisselcaninae is synonymized with Elcaninae, and a new subfamily (Archelcaninae subfam. nov.) is proposed for a segregate of Elcaninae. A preliminary comparison of the Purbeck/Wealden with other Early Cretaceous orthopteran faunas is given. (c) 2006 Published by Elsevier Ltd.

INSECT CHYMOTRYPSINS: CHLOROMETHYL KETONE INACTIVATION AND SUBSTRATE SPECIFICITY RELATIVE TO POSSIBLE COEVOLUTIONAL ADAPTATION OF INSECTS AND PLANTS

Insect digestive chymotrypsins are present in a large variety of insect orders but their substrate specificity still remains unclear. Ewer insect chymotrypsins from 3 different insect orders (Dictyoptera, Coleoptera and two Lepidoptera) were isolated using affinity chromatography. Enzymes presented molecular masses in the range of 20 to 31 kDa and pH optima in the range of 7.5 to 10.0. Kinetic characterization. using different, colorimetric and fluorescent substrates indicated that insect chymotrypsins differ from, bovine chymotrypsin in their primary specificity toward small substrates (like N-benzoyl-L-Tyr p-nitroanilide) rather than on their preference for large substrates (exemplified by Succynil-Ala-Ala-Pro-Phe P-nitroanilide). Chloromethyl ketones (TPCK, N-alpha-tosyl-L-Phe chloromethyl ketone and Z-GGF-CK, N-carbobenzoxy-Gly-Gly-phe-CK) inactivated all chymotrypsins legated. Inactivation rates follow apparent first-order kinetics with variable second order rates (TPCK, 42 to 130 M(-1)s(-1); Z-GGF-CK, 150 to 450 M(-1)s(-1) that may be remarkably low for S. frugiperda chymotrypsin (TPCK, 6 M(-1)s(-1); Z-GGF-CK, 6.1 M(-1) s(-1)). Homology modelling and sequence alignment showed that. in lepidopteran chymotrypsins, differences in the amino acid residues in the neighborhood of the catalytic His 57 may affect its pKa, value. This is Proposed as the cause of the decrease in His 57 reactivity toward chloromethyl ketones. Such amino acid replacement in the active site is proposed. to be an adaptation to the presence of dietary ketones. (C) 2009 Wiley Periodicals, Inc.