Compliance with recommendations in a geriatric outreach assessment service

Objectives: to measure the extent to which the recommendations of a geriatric outreach assessment service were being followed, and to determine what patient-related factors were associated with compliance with assessment recommendations. Methods: eighty-one eligible patients or caregivers who had an assessment in a geriatric outreach service participated in a telephone interview. The interview focused on the use of health services and compliance with assessment recomendations. Patient-related variables obtained from charts included demographics, caregiver support and stability, health status and assessment recommendations. Results: overall compliance with recommendations from the geriatric outreach assessment service was 65%. Patients were less likely comply fully with recommendations if they had a high number of recommendations [odds ratio (OR) = 0.23; 95% confidence interval (CI) = 0.12-0.46; P = 0.0001], inadequate caregiver support (OR) = 0.212; 95% CI = 0.04 to 1.02; P = 0.0523), or the ability to transfer themselves independently (OR = 0.12; 95% CI = 0.02-0.63; P = 0.0124). They were more likely to have full compliance if they had normal vision (OR = 6.67; 95% CI = 1.22- 36.46; P = 0.0284). Conclusion: it is important to focus on key issues when developing service recommendations and on the role of the informal caregiver in facilitating compliance with them. Good communication between the patient or caregiver and the family physician and geriatric services can help to identify strategies which might improve acceptance of recommendations.

Pseudo-endothelial dystrophy associated with emulsified silicone oil

Purpose. To describe endothelial changes associated with emulsified silicone oil. Methods. Report of a case. Results. A 77-year-old man had multiple and diffuse clear vesicles on the endothelium of his left eye (LE). The cornea was clear and thin. He had undergone pars plana vitrectomy and intraocular silicone oil injection 5 years before presentation. Specular microscopy revealed numerous small bubbles of emulsified silicone oil and a mild degree of endothelial damage. Conclusion. Emulsified silicone oil can adhere to the endothelium and induce an apparent droplet-like endotheliopathy.

Effects of process parameters upon the shape memory and pseudo-elastic behaviors of laser-welded NiTi thin foil

This article discusses the effects of laser welding parameters such as power, welding speed, and focus position on the weld bead profile, microstructure, pseudo-elasticity (PE), and shape memory effect (SME) of NiTi foil with thickness of 250 um using 100W CW fiber laser. The parameter settings to produce the NiTi welds for analysis in this article were chosen from a fractional factorial design to ensure the welds produced were free of any apparent defect. The welds obtained were mainly of cellular dendrites with grain sizes ranging from 2.5 to 4.8 um at the weld centerline. A small amount of Ni3Ti was found in the welds. The onset of transformation temperatures (As and Ms) of the NiTi welds shifted to the negative side as compared to the as-received NiTi alloy. Ultimate tensile stress of the NiTi welds was comparable to the as received NiTi alloy, but a little reduction in the pseudo-elastic property was noted. Full penetration welds with desirable weld bead profiles and mechanical properties were successfully obtained in this study.

Meeting the Requirements of the CDM Regulations: Identification of Critical Success Factors of Small to Medium Sized Contractor’ Compliance in the UK Construction Industry

The Construction Design and Management (CDM) Regulations (2007) is one of the most important set of health and safety regulations in the construction industry today. The aim of this research is to examine critical success factors for CDM compliance in small to medium size contractors in the UK construction industry. The objectives of the research include the identification of critical barriers in doing so along with the identification of success factors where CDM is incorporated. A mixed method approach is adopted in the identification and categorisation of the various factors encompassing a literature review, interviews and questionnaire survey. The key finding which emerge is the lack of knowledge and understanding with regards the CDM regulations with the recommendation to encourage small and medium contractor compliance through illustrating the benefits attainable. The practicality of the research is evident based on the significant uptake in the CDM by larger contractors, yet the research indicates that further insight and guidance is required to educate and inform those working within small to medium sized contractors in the UK. Where such acknowledgement and compliance is adopted, it is envisaged that this sector will benefit from reduced incidents and accidents, increased productivity while ultimately leading to a safer and more productive industry as a whole.

Disordered vascular compliance in haemochromatosis

Background: A relationship may exist between body iron stores, endothelial dysfunction and overall cardiovascular risk.

Aims: To compare vascular compliance, biochemical endothelial function and antioxidant status between patients with homozygous hereditary haemochromatosis and healthy controls.

Methods: Haemochromatosis patients and healthy controls were recruited. Measures of vascular compliance were assessed by applanation tonometry. Serological markers of endothelial function (plasma lipid hydroperoxides, cell adhesion molecules), antioxidant levels (ascorbate, lipid soluble antioxidants) and high-sensitivity C-reactive protein (CRP) were also measured.

Results: Thirty-five hereditary haemochromatosis patients (ten females, mean age 54.6) and 36 controls (27 female, mean age 54.0) were recruited. Haemochromatosis patients had significantly higher systolic and diastolic blood pressures. Pulse wave velocity (PWV) was significantly higher in male haemochromatosis patients (9.90 vs. 8.65 m/s, p = 0.048). Following adjustment for age and blood pressure, male haemochromatosis patients continued to have a trend for higher PWVs (+1.37 m/s, p = 0.058). Haemochromatosis patients had significantly lower levels of ascorbate (46.11 vs. 72.68 lmol/L, p = 0.011), retinol (1.17 vs. 1.81 lmol/L, p = 0.001) and g-tocopherol (2.51 vs. 3.14 lmol/L, p = 0.011). However, there was no difference in lipid hydroperoxides (0.46 vs. 0.47 nmol/L, p = 0.94), cell adhesion molecule levels (ICAM: 348.12 vs. 308.03 ng/mL, p = 0.32 and VCAM: 472.78 vs. 461.31 ng/mL, p = 0.79) or high-sensitivity CRP (225.01 vs. 207.13 mg/L, p = 0.32).

Conclusions: Haemochromatosis is associated with higher PWVs in males and diminished antioxidants across the sexes but no evidence of endothelial dysfunction or increased lipid peroxidation.

In pursuit of regulatory compliance: a study of planning enforcement structures in Northern Ireland

As devolution expands across the UK, Northern Ireland (NI) is witnessing the development of new architecture to devolve planning powers. With serious criticism targeted at the legislative provisions for enforcement, this investigation endeavours to assess the robustness of the planning framework through a synergy of theory, law and practice. The paper demonstrates the value of theory in not only supplying a lens that allows both legislative frameworks and praxis to be deconstructed, but also in enabling the identification and scrutiny of underlying problems that pervade the system.

Better understanding of mechanochemical reactions: Raman monitoring reveals surprisingly simple 'pseudo-fluid' model for a ball milling reaction

Quantitative monitoring of a mechanochemical reaction by Raman spectroscopy leads to a surprisingly straightforward second-order kinetic model in which the rate is determined simply by the frequency of reactive collisions between reactant particles.

Banking compliance and dependence corruption: towards an attachment perspective

Why did banking compliance fail so badly in the recent financial crisis and why, according to many, does it continue to do so? Rather than point to the lack of oversight of individuals in bank compliance roles, as many commentators do, in this paper I examine in depth the organizational context that surrounded people in such roles. I focus on those compliance personnel who did speak out about risky practices in their banks, who were forced to escalate the problem and 'whistle-blow' to external parties, and who were punished for doing so. Drawing on recent empirical data from a wider study, I argue that the concept of dependence corruption is useful in this setting, and that it can be extended to encompass interpersonal attachments. This, in turn, problematises the concept of dependence corruption because interpersonal attachments in organisational settings are inevitable. The paper engages with recent debates on whether institutional corruption is an appropriate lens for studying private-sector organisations by arguing for a focus on roles, rather than remaining at the level of institutional fields or individual organisations. Finally, the paper contributes to studies on banking compliance in the context of the recent crisis; without a deeper understanding of those who were forced to extremes to simply do their jobs, reform of the banking sector will prove difficult.

Comparison of 5% versus 15% sucrose intakes as part of a eucaloric diet in overweight and obese subjects:effects on insulin sensitivity, glucose metabolism, vascular compliance, body composition and lipid profile. A randomised controlled trial

AIMS: The effect of dietary sucrose on insulin resistance and the pathogenesis of diabetes and vascular disease is unclear. We assessed the effect of 5% versus 15% sucrose intakes as part of a weight maintaining, eucaloric diet in overweight/obese subjects.

METHODS: Thirteen subjects took part in a randomised controlled crossover study (M:F 9:4, median age 46 years, range 37-56 years, BMI 31.7±0.9 kg/m(2)). Subjects completed two 6 week dietary periods separated by 4 week washout. Diets were designed to have identical macronutrient profile. Insulin action was assessed using a two-step hyperinsulinaemic euglycaemic clamp; glucose tolerance, vascular compliance, body composition and lipid profiles were also assessed.

RESULTS: There was no change in weight or body composition between diets. There was no difference in peripheral glucose utilization or suppression of endogenous glucose production. Fasting glucose was significantly lower after the 5% diet. There was no demonstrated effect on lipid profiles, blood pressure or vascular compliance.

CONCLUSION: A low-sucrose diet had no beneficial effect on insulin resistance as measured by the euglycaemic glucose clamp. However, reductions in fasting glucose, one hour insulin and insulin area under the curve with the low sucrose diet on glucose tolerance testing may indicate a beneficial effect and further work is required to determine if this is the case. Clinical Trial Registration number ISRCTN50808730.

Pitfalls in Protection: How Theory Can Enrich Our Understanding of Regulatory Compliance Problems in Planning Practice

This paper responds to demands for greater academic investigation into environmental protection, specifically the practical and structural problems which underpin regulatory compliance in the planning system. It critiques traditional theories of regulation and answers calls for the development of a thematic lens to facilitate the scrutiny of not only operational practice, but also the broader institutional regime. An empirical investigation builds upon the construct of really responsive regulation to study planning control and it becomes apparent that not only are there significant procedural planning difficulties facing regulatory compliance, but also that a much wider raft of issues must be considered if the complex equation is to be solved. The findings demonstrate how theory can be applied to enrich our rudimentary understanding of deep-seated problems and foster insights into areas of structural importance which are relevant to both planning and the wider regulatory arena.

Endothelial function, antioxidant status and vascular compliance in newly diagnosed HFE C282Y homozygotes

Purpose: This pilot study was aimed to establish techniques for assessing and observing trends in endothelial function, antioxidant status and vascular compliance in newly diagnosed HFE haemochromatosis during the first year of venesection.

Patients/methods: Untreated newly diagnosed HFE haemochromatosis patients were tested for baseline liver function, iron indices, lipid profile, markers of endothelial function, anti-oxidant status and vascular compliance. Following baseline assessment, subjects attended at 6-weeks and at 3, 6, 9 and 12-months for follow-up studies.

Results: Ten patients were recruited (M = 8, F = 2, mean age = 51 years). Venesection significantly increased high density lipoproteins at 12-months (1.25 mmol/L vs. 1.37 mmol/L, p = 0.01). However, venesection did not significantly affect lipid hydroperoxides, intracellular and vascular cell adhesion molecules or high sensitivity C-reactive protein (0.57 mu mol/L vs. 0.51 mu mol/L, p = 0.45, 427.4 ng/ml vs. 307.22 ng/ml, p = 0.54, 517.70 ng/ml vs. 377.50 ng/ml, p = 0.51 and 290.75 mu g/dL vs. 224.26 mu g/dL, p = 0.25). There was also no significant effect of venesection on anti-oxidant status or pulse wave velocity (9.65 m/s vs. 8.74 m/s, p = 0.34).

Conclusions: Venesection significantly reduced high density lipoproteins but was not associated with significant changes in endothelial function, anti-oxidant status or vascular compliance. Larger studies using this established methodology are required to clarify this relationship further. 

Cockney, pseudo-slang et argot de série noire : San-Antonio et le moment Peter Cheyney du roman noir français

This article examines how in post-war France slang became a byword for the noir genre. It considers the mechanisms, models, networks and translators' practices which set the tone for the "Série Noire”, whose influence, both written and on the screen, had, within a decade, become, a "mythology" studied by Roland Barthes. It argues that this use of slang is redolent of the inauthenticity which characterises this stage in the reception of the Noir genre in France. It is certain that this artificial French slang is far from devoid of charm, or even mystery. But it tends to depreciate and deform the translated works and seems to be the hallmark of an era that might have defined and acclimatised Noir fiction in France, yet remains one which has not fully understood the gravity of its purpose. While such translations seem outdated nowadays (if not quite incomprehensible ), original works written at the time in French by writers inspired by the model of " pseudo- slang" and the fashionability of American popular culture have benefited from them. In this very inauthenticity, derivative novels have found a licence for invention and freedom, with authors such as Cocteau hailing it as a revival of the French written language. We see here how the adventures of Commissaire San Antonio, by Frédéric Dard constitute the best examples of this new creativity in French and draw upon a template set for the reception of American literature