Outcome Measures in Glaucoma:A Systematic Review of Cochrane Reviews and Protocols

In clinical trials, the selection of appropriate outcomes is crucial for the assessment of whether one intervention is better than another. Selection of inappropriate outcomes can compromise the utility of a trial. However, the process of selecting the most suitable outcomes to include can be complex. Ideally, glaucoma trials aim to evaluate important outcomes for clinicians and patients. A high variability in the selection of outcomes suggests that there is no consensus on how best to evaluate the effect of glaucoma interventions. Further, it makes evidence synthesis difficult. The purpose of this review is to determine the extent of clinical outcome measures used in published glaucoma Cochrane Reviews and Protocols.

Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review

Background: Although disabled women are significantly more likely to experience domestic abuse during pregnancy than non-disabled women, very little is known about how maternity care access and utilisation is affected by the co-existence of disability and domestic abuse. This systematic review of the literature explored how domestic abuse impacts upon disabled women’s access to maternity services.

Methods: Eleven articles were identified through a search of six electronic databases and data were analysed to identify: the factors that facilitate or compromise access to care; the consequences of inadequate care for pregnant women’s health and wellbeing; and the effectiveness of existing strategies for improvement.

Results: Findings indicate that a mental health diagnosis, poor relationships with health professionals and environmental barriers can compromise women’s utilisation of maternity services. Domestic abuse can both compromise, and catalyse, access to services and social support is a positive factor when accessing care. Delayed and inadequate care has adverse effects on women’s physical and psychological health, however further research is required to fully explore the nature and extent of these consequences. Only one study identified strategies currently being used to improve access to services for disabled women experiencing abuse.

Conclusions: Based upon the barriers and facilitators identified within the review, we suggest that future strategies for improvement should focus on: understanding women’s reasons for accessing care; fostering positive relationships; being women-centred; promoting environmental accessibility; and improving the strength of the evidence base.

Detection of cardiac arrest using a simplified frequency analysis of the impedance cardiogram recorded from defibrillator pads

An algorithm based only on the impedance cardiogram (ICG) recorded through two defibrillation pads, using the strongest frequency component and amplitude, incorporated into a defibrillator could determine circulatory arrest and reduce delays in starting cardiopulmonary resuscitation (CPR). Frequency analysis of the ICG signal is carried out by integer filters on a sample by sample basis. They are simpler, lighter and more versatile when compared to the FFT. This alternative approach, although less accurate, is preferred due to the limited processing capacity of devices that could compromise real time usability of the FFT. These two techniques were compared across a data set comprising 13 cases of cardiac arrest and 6 normal controls. The best filters were refined on this training set and an algorithm for the detection of cardiac arrest was trained on a wider data set. The algorithm was finally tested on a validation set. The ICG was recorded in 132 cardiac arrest patients (53 training, 79 validation) and 97 controls (47 training, 50 validation): the diagnostic algorithm indicated cardiac arrest with a sensitivity of 81.1% (77.6-84.3) and specificity of 97.1% (96.7-97.4) for the validation set (95% confidence intervals). Automated defibrillators with integrated ICG analysis have the potential to improve emergency care by lay persons enabling more rapid and appropriate initiation of CPR and when combined with ECG analysis they could improve on the detection of cardiac arrest.

Flexible energetics of cheetah hunting strategies provide resistance against kleptoparasitism

Population viability is driven by individual survival, which in turn depends on individuals balancing energy budgets. As carnivores may function close to maximum sustained power outputs, decreased food availability or increased activity may render some populations energetically vulnerable. Prey theft may compromise energetic budgets of mesopredators, such as cheetahs and wild dogs, which are susceptible to competition from larger carnivores. We show that daily energy expenditure (DEE) of cheetahs was similar to size-based predictions and positively related to distance traveled. Theft at 25% only requires cheetahs to hunt for an extra 1.1 hour per day, increasing DEE by just 12%. Therefore, not all mesopredators are energetically constrained by direct competition. Other factors that increase DEE, such as those that increase travel, may be more
important for population viability.

Preaggregated Ag Nanoparticles in Dry Swellable Gel Films for Off-the-Shelf Surface-Enhanced Raman Spectroscopy

Large, thin (50 mu m) dry polymer sheets containing numerous surface-enhanced Raman spectroscopy (SERS) active Ag nanopartide aggregates have been prepared by drying aqueous mixtures of hydroxyethylcelloulose (HEC) and preaggregated Ag colloid in 10 x 10 cm molds. In these dry films, the particle aggregates are protected from the environment during storage and are easy to handle; for example, they can be cut to size with scissors. When in use, the highly swellable HEC polymer allowed the films to rapidly absorb aqueous analyte solutions while simultaneously releasing the Ag nanoparticle aggregates to interact with the analyte and generate large SERS signals. Either the films could be immersed in the analyte solution or 5 mu L droplets were applied to the surface; in the latter method, the local swelling caused the active area to dome upward, but the swollen film remained physically robust and could be handled as required. Importantly, encapsulation and release did not significantly compromise the SERS performance of the colloid; the signals given by the swollen films were similar to the very high signals obtained from the parent citrate-reduced colloid and were an order of magnitude larger than a commercially available nanoparticle substrate. These "Poly-SERS" films retained 70% of their SERS activity after being stored for 1 year in air. The films were sufficiently homogeneous to give a standard deviation of 3.2% in the absolute signal levels obtained from a test analyte, primarily due to the films' ability to suppress "coffee ring" drying marks, which meant that quantitative analysis without an internal standard was possible. The majority of the work used aqueous thiophenol as the test analyte; however, preliminary studies showed that the Poly-SERS films could also be used with nonaqueous solvents and for a range of other analytes including theophylline, a therapeutic drug, at a concentration as low as 1.0 x 10(-5) mol dm(-3) (1.8 mg/dm(3)), well below the sensitivity required for theophylline monitoring where the target range is 10-20 mg/dm(3).

The Relationship Between Cumulative Adversity in Childhood and Adolescent Suicide and Accidental Death

On the whole research has concluded that most young people navigate adolescence with few difficulties, but a minority do find this stage of life challenging, and their ways of coping may have negative consequences for both themselves and others. For some the experience of adversity in earlier childhood, and the cumulative impact of multiple adversities has the potential to compromise a young person’s natural resilience. In some cases this may result in an adolescent feeling overwhelmed, and dying through suicide or other high risk behaviours. This article explores these issues with reference to eight young people who died by suicide in Northern Ireland. The article argues that young people exposed to multiple adversities in childhood require earlier, more sustained and better co-ordinated services from professionals if their psychological and emotional well-being is to be promoted.

Effective grain size distribution analysis for interpretation of tidal-deltaic facies: West Bengal Sundarbans

Research over the past two decades on the Holocene sediments from the tide dominated west side of the lower Ganges delta has focussed on constraining the sedimentary environment through grain size distributions (GSD). GSD has traditionally been assessed through the use of probability density function (PDF) methods (e.g. log-normal, log skew-Laplace functions), but these approaches do not acknowledge the compositional nature of the data, which may compromise outcomes in lithofacies interpretations. The use of PDF approaches in GSD analysis poses a series of challenges for the development of lithofacies models, such as equifinal distribution coefficients and obscuring the empirical data variability. In this study a methodological framework for characterising GSD is presented through compositional data analysis (CODA) plus a multivariate statistical framework. This provides a statistically robust analysis of the fine tidal estuary sediments from the West Bengal Sundarbans, relative to alternative PDF approaches.

ELM-induced transient tungsten melting in the JET divertor

The original goals of the JET ITER-like wall included the study of the impact of an all W divertor on plasma operation (Coenen et al 2013 Nucl. Fusion 53 073043) and fuel retention (Brezinsek et al 2013 Nucl. Fusion 53 083023). ITER has recently decided to install a full-tungsten (W) divertor from the start of operations. One of the key inputs required in support of this decision was the study of the possibility of W melting and melt splashing during transients. Damage of this type can lead to modifications of surface topology which could lead to higher disruption frequency or compromise subsequent plasma operation. Although every effort will be made to avoid leading edges, ITER plasma stored energies are sufficient that transients can drive shallow melting on the top surfaces of components. JET is able to produce ELMs large enough to allow access to transient melting in a regime of relevance to ITER.

Transient W melt experiments were performed in JET using a dedicated divertor module and a sequence of I-P = 3.0 MA/B-T = 2.9 T H-mode pulses with an input power of P-IN = 23 MW, a stored energy of similar to 6 MJ and regular type I ELMs at Delta W-ELM = 0.3 MJ and f(ELM) similar to 30 Hz. By moving the outer strike point onto a dedicated leading edge in the W divertor the base temperature was raised within similar to 1 s to a level allowing transient, ELM-driven melting during the subsequent 0.5 s. Such ELMs (delta W similar to 300 kJ per ELM) are comparable to mitigated ELMs expected in ITER (Pitts et al 2011 J. Nucl. Mater. 415 (Suppl.) S957-64).

Although significant material losses in terms of ejections into the plasma were not observed, there is indirect evidence that some small droplets (similar to 80 mu m) were released. Almost 1 mm (similar to 6 mm(3)) of W was moved by similar to 150 ELMs within 7 subsequent discharges. The impact on the main plasma parameters was minor and no disruptions occurred. The W-melt gradually moved along the leading edge towards the high-field side, driven by j x B forces. The evaporation rate determined from spectroscopy is 100 times less than expected from steady state melting and is thus consistent only with transient melting during the individual ELMs. Analysis of IR data and spectroscopy together with modelling using the MEMOS code Bazylev et al 2009 J. Nucl. Mater. 390-391 810-13 point to transient melting as the main process. 3D MEMOS simulations on the consequences of multiple ELMs on damage of tungsten castellated armour have been performed.

These experiments provide the first experimental evidence for the absence of significant melt splashing at transient events resembling mitigated ELMs on ITER and establish a key experimental benchmark for the MEMOS code.

When innovation fails: An institutional perspective of the (non)adoption of boundary spanning IT innovation

We combine the concepts of legitimacy, institutional (mis)alignments, strategic responses and organizing visions to develop a conceptual framework to analyse the adoption of innovations that span organisational fields. We apply the framework to examine a telehealth innovation connecting a public sector hospital-based eye clinic with private sector optometry practices. We find that while compromise strategies were successful in encouraging adoption within each field, the innovation ultimately failed as fields developed different organising visions which could not be reconciled. The findings suggest that institutional misalignments within and between fields interact to amplify their overall effect on the adoption of hybrid innovations.

Conflict and Consensus

There are widely differing conceptions as to whether healthy social relations are, in essence, conflictual or consensual; such differences give rise to different approaches to finding peace and managing power. This article outlines the two broad schools of thought from conflict theory (in which society functions through competition) and consensus theory (which sees society developing through cooperation). It outlines the middle ground between them, as found by pluralism and agonism, before considering the ways in which assumptions vis-a-vis conflict and consensus are reflected in different models of democratic system and, in particular, different priorities for post-conflict recovery.

A DFT study of the transition metal promotion effect on ethylene chemisorption on Co(0001)

Transition metals are often introduced to a catalyst as promoters to improve catalytic performance. In this work, we study the promotion effect of transition metals on Co, the preferred catalytic metal for Fischer-Tropsch synthesis because of its good compromise of activity, selectivity and stability, for ethylene chemisorption using density functional theory (DFT) calculations, aiming to provide some insight into improving the alpha-olefin selectivity. In order to obtain the general trend of influence on ethylene chemisorption, twelve transition metals (Zr, Mn, Re, Ru, Rh, It, Ni, Pd, Pt, Cu, Ag and Au) are calculated. We find that the late transition metals (e.g. Pd and Cu) can decrease ethylene chemisorption energy. These results suggest that the addition of the late transition metals may improve alpha-olefin selectivity. Electronic structure analyses (both charge density distributions and density of states) are also performed and the understanding of calculated results is presented. (C) 2009 Elsevier B.V. All rights reserved.

Riots and Reactions: Hypocrisy and Disaffiliation?

The August 2011 riots in England occasioned widespread condemnation from government and the media. Here, we apply the concepts of hypocrisy and affiliation to explore reactions to these riots. Initially acknowledging that politics necessitates a degree of hypocrisy, we note that some forms of hypocrisy are indefensible: they compromise injavascript:void(0);tegrity. With rioters condemned as thugs and members of a feral underclass, some reactions exemplified forms of corrosive hypocrisy that deflected attention away from economic, social and cultural problems. Moreover, such reactions omitted to attend to the concept of [dis]affiliation amongst young rioters. Accordingly, we look to the role that education might play in re-affiliating those who do not feel they belong to, or have a sufficient stake in, society. Whilst our focus is on the riots in England, the exploration of hypocrisy and affiliation, and discussion of education for re-affiliation, transcends that national context.

Disabled women’s experiences of accessing and utilising maternity services when they are affected by domestic abuse: a critical incident technique study

Background: Women and their babies are entitled to equal access to high quality maternity care. However, when women fit into two or more categories of vulnerability they can face multiple, compound barriers to accessing and utilising services. Disabled women are up to three times more likely to experience domestic abuse than non-disabled women. Domestic abuse may compromise health service access and utilisation and disabled people in general have suboptimal access to healthcare services. Despite this, little is known about the compounding effects of disability and domestic abuse on women’s access to maternity care.

Methods: The aim of the study was to identify how women approach maternity care services, their expectations of services and whether they are able to get the type of care that they need and want. We conducted a qualitative, Critical Incident Technique study in Scotland. Theoretically we drew on Andersen’s model of healthcare use. The model was congruent with our interest in women’s intended/actual use of maternity services and the facilitators and barriers
impacting their access to care. Data were generated during 2013 using one-to-one interviews.

Results: Five women took part and collectively reported 45 critical incidents relating to accessing and utilising maternity services. Mapped to the underpinning theoretical framework, our findings show how the four domains of attitudes; knowledge; social norms; and perceived control are important factors shaping maternity care experiences.

Conclusions: Positive staff attitude and empowering women to have control over their own care is crucial in influencing women’s access to and utilisation of maternity healthcare services. Moreover these are cyclical, with the consequences and outcomes of healthcare use becoming part of the enabling or disabling factors affecting future healthcare decisions.Further consideration needs to be given to the development of strategies to access and recruit women in these circumstances. This will provide an opportunity for under-represented and silenced voices to be heard.

A Numerical and Experimental Assessment of the Use of a Turbine Utilizing Splitter Blades for an Automotive Variable Geometry Turbocharger

Automotive manufacturers require improved part load engine performance to further improve fuel economy. For a swing vane VGS (Variable Geometry Stator) turbine this means a more closed stator vane, to deal with the low MFRs (Mass Flow Rates), high PRs (Pressure Ratios) and low rotor rotational speeds. During these conditions the turbine is operating at low velocity ratios. As more energy is available at high pressure ratios and during lower turbocharger rotational speeds, a turbine which is efficient at these conditions is desirable. Another key aspect for automotive manufacturers is engine responsiveness. High inertia designs result in “turbo lag” which means an increased time before the target boost pressure is reached. Therefore, designs with improved performance at low velocity ratios, reduced inertia or an increased swallowing capacity are the current targets for turbocharger manufacturers.

To try to meet these design targets a CFD (Computational Fluid Dynamics) study was performed on a turbine wheel using splitter blades. A number of parameters were investigated. These included splitter blade merdional length, blade number and blade angle distribution.

The numerical study was performed on a scaled automotive VGS. Three different stator vane positions have been analysed. A single passage CFD model was developed and used to provide information on the flow features affecting performance in both the stator vanes and turbine.

Following the CFD investigation the design with the best compromise in terms of performance, inertia and increased MFP (Mass Flow Parameter) was selected for manufacture and testing. Tests were performed on a scaled, low temperature turbine test rig. The aerodynamic flow path of the gas stand was the same as that investigated during the CFD. The test results revealed a design which had similar performance at the closed stator vane positions when compared to the baseline wheel. At the maximum MFR stator vane condition a drop of −0.6% pts in efficiency was seen. However, 5.5% increase in MFP was obtained with the additional benefit of a drop in rotor inertia of 3.7%, compared to the baseline wheel.

Evaluating fault tolerance on asymmetric multicore systems-on-chip using iso-metrics

The end of Dennard scaling has promoted low power consumption into a firstorder concern for computing systems. However, conventional power conservation schemes such as voltage and frequency scaling are reaching their limits when used in performance-constrained environments. New technologies are required to break the power wall while sustaining performance on future processors. Low-power embedded processors and near-threshold voltage computing (NTVC) have been proposed as viable solutions to tackle the power wall in future computing systems. Unfortunately, these technologies may also compromise per-core performance and, in the case of NTVC, xreliability. These limitations would make them unsuitable for HPC systems and datacenters. In order to demonstrate that emerging low-power processing technologies can effectively replace conventional technologies, this study relies on ARM’s big.LITTLE processors as both an actual and emulation platform, and state-of-the-art implementations of the CG solver. For NTVC in particular, the paper describes how efficient algorithm-based fault tolerance schemes preserve the power and energy benefits of very low voltage operation.