Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: A quasi-experimental study

Background There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). Methods A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. Results Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67–0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50–0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43–0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65–0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54–0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61–1.11); p = 0.196). Conclusions Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.

Polybridge Technical Report

This study examined the physical and chemical properties of a novel, fully-recirculated prawn and polychaete production system that incorporated polychaete-assisted sand filters (PASF). The aims were to assess and demonstrate the potential of this system for industrialisation, and to provide optimisations for wastewater treatment by PASF. Two successive seasons were studied at commercially-relevant scales in a prototype system constructed at the Bribie Island Research Centre in Southeast Queensland. The project produced over 5.4 tonnes of high quality black tiger prawns at rates up to 9.9 tonnes per hectare, with feed conversion of up to 1.1. Additionally, the project produced about 930 kg of high value polychaete biomass at rates up to 1.5 kg per square metre of PASF, with the worms feeding predominantly on waste nutrients. Importantly, this closed production system demonstrated rapid growth of healthy prawns at commercially relevant production levels, using methods that appear feasible for application at large scale. Deeper (23 cm) PASF beds provided similar but more reliable wastewater treatment efficacies compared with shallower (13 cm) beds, but did not demonstrate significantly greater polychaete productivity than (easier to harvest) shallow beds. The nutrient dynamics associated with seasonal and tidal operations of the system were studied in detail, providing technical and practical insights into how PASF could be optimised for the mitigation of nutrient discharge. The study also highlighted some of the other important advantages of this integrated system, including low sludge production, no water discharge during the culture phase, high ecosystem health, good prospects for biosecurity controls, and the sustainable production of a fishery-limited resource (polychaetes) that may be essential for the expansion of prawn farming industries throughout the world. Regarding nutrient discharge from this prototype mariculture system, when PASF was operating correctly it proved feasible to have no water (or nutrient) discharge during the entire prawn growing season. However, the final drain harvest and emptying of ponds that is necessary at the end of the prawn farming season released 58.4 kg ha-1 of nitrogen and 6 kg ha-1 of phosphorus (in Season 2). Whilst this is well below (i.e., one-third to one-half of) the current load-based licencing conditions for many prawn farms in Australia, the levels of nitrogen and chlorophyll a in the ponds remained higher than the more-stringent maximum limits at the Bribie Island study site. Zero-net-nutrient discharge was not achieved, but waste nutrients were low where 5.91 kg of nitrogen and 0.61 kg of phosphorus was discharged per tonne of prawns produced. This was from a system that deployed PASF at 14.4% of total ponded farm area which treated an average of 5.8% of pond water daily and did not use settlement ponds or other natural or artificial water remediation systems. Four supplemental appendices complement this research by studying several additional aspects that are central to the industrialisation of PASF. The first details an economic model and decision tool which allows potential users to interactively assess construction and operational variables of PASF at different scales. The second provides the qualitative results of a prawn maturation trial conducted collaboratively with the Commonwealth Scientific and Industrial Research Organisation (CSIRO) to assess dietary inclusions of PASF-produced worms. The third provides the reproductive results from industry-based assessments of prawn broodstock produced using PASF. And the fourth appendix provides detailed elemental and nutritional analyses of bacterial biofilm produced by PASF and assesses its potential to improve the growth of prawns in recirculated culture systems.

The architecture of the psychiatric milieu

The last time a peer-reviewed volume on the future of mental health facilities was produced was in 1959, following a symposium organised by the American Psychological Association. The consensus was easy enough to follow and still resonates today: the best spaces to treat psychiatric illness will be in smaller, less restrictive units that offer more privacy and allow greater personalisation of space – possibly a converted hotel (Goshen, 1959). In some way, all those ideals have come to pass. An ideal typology was never established, but even so, units have shrunk from thousands of beds to units that typically house no more than 50 patients. Patients are generally more independent and are free to wander (within a unit) as they please. But the trend toward smaller and freer is reversing. This change is not driven by a desire to find the ideal building nor better models of care, but by growing concerns about budgets, self-harm and psychiatric violence. This issue of the Facilities comes at a time when the healthcare design is increasingly dominated by codes, statutes and guidelines. But the articles herein are a call to stop and think. We are not at the point where guidelines can be helpful, because they do not embody any depth of knowledge nor wisdom. These articles are intended to inject some new research on psychiatric/environmental interactions and also to remind planners and managers that guidelines might not tackle a core misunderstanding: fear-management about patient safety and the safety of society is not the purpose of the psychiatric facility. It is purpose is to create spaces that are suitable for improving the well-being of the mentally ill.

In bed with technology: Challenges and opportunities for sleep tracking

In recent years a variety of mobile apps, wearable technologies and embedded systems have emerged that allow individuals to track the amount and the quality of their sleep in their own beds. Despite the widespread adoption of these technologies, little is known about the challenges that current users face in tracking and analysing their sleep. Hence we conducted a qualitative study to examine the practices of current users of sleep tracking technologies and to identify challenges in current practice. Based on data collected from 5 online forums for users of sleep-tracking technologies, we identified 22 different challenges under the following 4 themes: tracking continuity, trust, data manipulation, and data interpretation. Based on these results, we propose 6 design opportunities to assist researchers and practitioners in designing sleep-tracking technologies.

Population dynamics of blue mussels in a variable environment at the edge of their range

Spatial and temporal variation in the abundance of species can often be ascribed to spatial and temporal variation in the surrounding environment. Knowledge of how biotic and abiotic factors operate over different spatial and temporal scales in determining distribution, abundance, and structure of populations lies at the heart of ecology. The major part of the current ecological theory stems from studies carried out in central parts of the distributional range of species, whereas knowledge of how marginal populations function is inadequate. Understanding how marginal populations, living at the edge of their range, function is however in a key position to advance ecology and evolutionary biology as scientific disciplines. My thesis focuses on the factors affecting dynamics of marginal populations of blue mussels (Mytilus edulis) living close to their tolerance limits with regard to salinity. The thesis aims to highlight the dynamics at the edge of the range and contrast these with dynamics in more central parts of the range in order to understand the potential interplay between the central and the marginal part in the focal system. The objectives of the thesis are approached by studies on: (1) factors affecting regional patterns of the species, (2) long-term temporal dynamics of the focal species spaced along a regional salinity gradient, (3) selective predation by increasing populations of roach (Rutilus rutilus) when feeding on their main food item, the blue mussel, (4) the primary and secondary effects of local wave exposure gradients and (5) the role of small-scale habitat heterogeneity as determinants of large-scale pattern. The thesis shows that populations of blue mussels are largely determined by large scale changes in sea water salinity, affecting mainly recruitment success and longevity of local populations. In opposite to the traditional view, the thesis strongly indicate that vertebrate predators strongly affect abundance and size structure of blue mussel populations, and that the role of these predators increases towards the margin where populations are increasingly top-down controlled. The thesis also indicates that the positive role of biogenic habitat modifiers increases towards the marginal areas, where populations of blue mussels are largely recruitment limited. Finally, the thesis shows that local blue mussel populations are strongly dependent on high water turbulence, and therefore, dense populations are constrained to offshore habitats. Finally, the thesis suggests that ongoing sedimentation of rocky shores is detrimental for the species, affecting recruitment success and post-recruit survival, pushing stable mussel beds towards offshore areas. Ongoing large scale changes in the Baltic Sea, especially dilution processes with attendant effects, are predicted to substantially contract the distributional range of the mussel, but also affect more central populations. The thesis shows that in order to understand the functioning of marginal populations, research should (1) strive for multi-scale approaches in order to link ecosystem patterns with ecosystem processes, and (2) challenge the prevailing tenets that origin from research carried out in central areas that may not be valid at the edge.

Lymphatic vascular maturation : Roles of FOXC2, NFATc1 and liprin ß1

The blood vascular system is a closed circulatory system, responsible for delivering oxygen and nutrients to the tissues. In contrast, the lymphatic vascular system is a blind-ended transport system that collects the extravasated tissue fluid from the capillary beds, and transports it back to the blood circulation. Failure in collecting or transporting the lymph, due to defects in the lymphatic vasculature, leads to accumulation of extra fluid in the tissues, and consequently to tissue swelling lymphedema. The two vascular systems function in concert. They are structurally related, but their development is regulated by separate, however overlapping, molecular mechanisms. During embryonic development, blood vessels are formed by vasculogenesis and angiogenesis, processes largely mediated by members of the vascular endothelial growth factor (VEGF) family and their tyrosine kinase receptors. The lymphatic vessels are formed after the cardiovascular system is already functional. This process, called lymphangiogenesis, is controlled by distinct members of the VEGF family, together with the transcription factors Prox1 and Sox18. After the primary formation of the vessels, the vasculature needs to mature and remodel into a functional network of hierarchically organized vessels: the blood vasculature into arteries, capillaries and veins; and the lymphatic vasculature into lymphatic capillaries, responsible for the uptake of the extravasated fluid from the tissues, and collecting vessels, responsible for the transport of the lymph back to the blood circulation. A major event in the maturation of the lymphatic vasculature is the formation of collecting lymphatic vessels. These vessels are characterized by the presence of intraluminal valves, preventing backflow of the lymph, and a sparse coverage of smooth muscle cells, which help in pumping the lymph forward. In our study, we have characterized the molecular and morphological events leading to formation of collecting lymphatic vessels. We found that this process is regulated cooperatively by the transcription factors Foxc2 and NFATc1. Mice lacking either Foxc2 or active NFATc1 fail to remodel the primary lymphatic plexus into functional lymphatic capillaries and collecting vessels. The resulting vessels lack valves, display abnormal expression of lymphatic molecules, and are hyperplastic. Moreover, the lymphatic capillaries show aberrant sprouting, and are abnormally covered with smooth muscle cells. In humans, mutations in FOXC2 lead to Lymphedema-Distichiasis (LD), a disabling disease characterized by swelling of the limbs due to insufficient lymphatic function. Our results from Foxc2 mutant mice and LD patients indicate that the underlying cause for lymphatic failure in LD is agenesis of collecting lymphatic valves and aberrant recruitment of periendothelial cells and basal lamina components to lymphatic capillaries. Furthermore, we show that liprin β1, a poorly characterized member of the liprin family of cytoplasmic proteins, is highly expressed in lymphatic endothelial cells in vivo, and is required for lymphatic vessel integrity. These data highlight the important role of FOXC2, NFATc1 and liprin β1 in the regulation of lymphatic development, specifically in the maturation and formation of the collecting lymphatic vessels. As damage to collecting vessels is a major cause of lymphatic dysfunction in humans, our results also suggest that FOXC2 and NFATc1 are potential targets for therapeutic intervention.

The tectonic significance of lower Permain successions in the Texas Orocline (Eastern Australia)

The Texas Orocline is a prominent orogenic curvature that developed during the early Permian in the southern New England Orogen. Outliers preserving lower Permian sedimentary successions (Bondonga, Silver Spur, Pikedale, Terrica, Alum Rock and Ashford beds) approximately outline the oroclinal structure, but the tectonic processes responsible for the development of these basinal successions, and their relationships to the Texas Orocline, are unclear. Here we address this shortcoming by providing new U–Pb detrital and primary zircon ages from these successions, as well as detailed stratigraphic and structural data from the largest exposed succession (Bondonga beds). Field observations and U–Pb geochronological data suggest that the lower Permian successions in the Texas Orocline are remnants of a single, formerly larger basin that was deposited after ca 302 Ma. Time constraints for formation of this basin are correlative with constraints from the lower Permian Nambucca Block, which was likely deposited in response to regional back-arc extension during and/or after the development of the Texas Orocline. The conclusion that the lower Permian sedimentary basins in the Texas Orocline belong to this back-arc extensional system supports the suggestion that oroclinal bending in the New England Orogen was primarily controlled by trench retreat and associated overriding-plate extension.

Effect of reinforcement form on the bearing capacity of square footings on sand

This paper presents the results of laboratory model loading tests and numerical studies carried out on square footings supported on geosynthetic reinforced sand beds. The relative performance of different forms of geosynthetic reinforcement (i.e. geocell, planar layers and randomly distributed mesh elements) in foundation beds is compared; using same quantity of reinforcement in each test. A biaxial geogrid and a geonet are used for reinforcing the sand beds. Geonet is used in two forms of reinforcement, viz. Planar layers and geocell, while the biaxial geogrid was used in three forms of reinforcement, viz. planar layers, geocell and randomly distributed mesh elements. Laboratory load tests on unreinforced and reinforced footings are simulated in a numerical model and the results are analyzed to understand the distribution of displacements and stresses below the footing better. Both the experimental and numerical studies demonstrated that the geocell is the most advantageous form of soil reinforcement technique of those investigated, provided there is no rupture of the material during loading. Geogrid used in the form of randomly distributed mesh elements is found to be inferior to the other two forms. Some significant observations on the difference in reinforcement mechanism for different forms of reinforcement are presented in this paper.

Long-lived giant number fluctuations in a swarming granular nematic

Coherently moving flocks of birds, beasts, or bacteria are examples of living matter with spontaneous orientational order. How do these systems differ from thermal equilibrium systems with such liquid crystalline order? Working with a fluidized monolayer of macroscopic rods in the nematic liquid crystalline phase, we find giant number fluctuations consistent with a standard deviation growing linearly with the mean, in contrast to any situation where the central limit theorem applies. These fluctuations are long-lived, decaying only as a logarithmic function of time. This shows that flocking, coherent motion, and large-scale inhomogeneity can appear in a system in which particles do not communicate except by contact.

Immobilization of Aspergillus oryzae alpha-galactosidase in gelatin and its application in removal of flatulence-inducing sugars in soymilk

Raffinose oligosaccharides (RO) are the major factors responsible for flatulence following ingestion of soybean-derived products. Removal of RO from seeds or soymilk would then have a positive impact on the acceptance of soy-based foods. In this study, alpha-galactosidase from Aspergillus oryzae was entrapped in gelatin using formaldehyde as the hardener. The immobilization yield was 64.3% under the optimum conditions of immobilization. The immobilized alpha-galactosidase showed a shift in optimum pH from 4.8 to 5.4 in acetate buffer. The optimum temperature also shifted from 50 degrees C to 57 degrees C compared with soluble enzyme. Immobilized alpha-galactosidase was used in batch, repeated batch and continuous mode to degrade RO present in soymilk. In the repeated batch, 45% reduction of RO was obtained in the fourth cycle. The performance of immobilized alpha-galactosidase was tested in a fluidized bed reactor at different flow rates and 86% reduction of RO in soymilk was obtained at 25 ml h(-1) flow rate. The study revealed that immobilized alpha-galactosidase in continuous mode is efficient in reduction of RO present in soymilk.

Design of plane sand-bed channels affected by seepage

The importance of seepage in the design of channels is discussed. Experimental investigations reveal that seepage, either in the downward direction (suction) or in the upward direction (injection), can significantly change the resistance as well as the mobility of the sand-bed particles. A resistance equation relating 'particle Reynolds number' and 'shear Reynolds number' under seepage conditions is developed for plane sediment beds. Finally, a detailed design procedure of the plane sediment beds affected by seepage is presented.

Matkailurakentaminen ja sen diskursiivinen rakentuminen Kilpisjärvellä

This master s thesis examines tourism related housing and related discourses in the village of Kilpisjärvi, Finland. I study the tourism development in Kilpisjärvi and the debate related to this process. My methodology is based on discourse and content analysis. The purpose of this study is to examine and classify the discourses of tourism related housing and what are the lessons learned from the recent development of Kilpisjärvi. Kilpisjärvi is the northernmost village in western Finnish Lapland, located in the middle of the highest mountain area of Finland. The area has been reindeer herding area of Saami people for centuries, but it has lacked permanent settlement until the beginning of 20th century. The first tourist accommodation was built in 1930s, followed by the road in 1940s and the hotel in 1950s. Traditionally the area has attracted skiers and hikers. The area is also known for its extraordinary nature and rare plant life. Tourism development was slow in Kilpisjärvi until the turn of millennium when rapid growth in tourism related housing was triggered by extensive land use planning. Small wilderness village of Kilpisjärvi has grown to a tourism centre with over 800 beds in commercial enterprises, more than hundred second-homes, and two large caravan areas. This development has raised conflicts among villagers. The empirical part of this study is based on the interviews of 17 permanent dwellers of Kilpisjärvi and three Norwegian cottage owners. Six discourses can be distinguished: 1) Nature and landscape, 2) Economy, 3) Place, 4)Reindeer herding, 5) Governance and 6) Possibilities to influence decision-making. The first discourse stressed that tourism development and building should adapt to nature and landscape, while economic discourse stressed the economical importance of tourism to Kilpisjärvi and the municipality of Enontekiö. The third discourse noted the change of Kilpisjärvi as a place due to the boom of tourism development. The discourse of reindeer herding was clearly distinguished from others, seeing tourism development merely negative. Governance was seen as an important tool in regulating development, but many saw that the municipal administration has failed to take into account other aspects of tourism development than economical factors. Many villagers saw their influence in decision-making weak, while landowners and municipal decision-makers were seen as oligarchy in land-use planning regardless of formal participatory planning process enforced by law. I conclude that it is important to take into account the diversity of local discourses in tourism development and land use issues. Transparent and genuine participatory planning process would promote sustainable development, prevent conflicts and allow decisions and development which would satisfy larger number of local dwellers than presently.

Catalytic dehydrogenation of 2-propanol to acetone

Catalytic dehydrogenation of 2-propanol over Cu-SiO2 catalyst was investigated. The undesired side reaction of dehydration can be controlled by a selective catalyst and choice of proper operating conditions. The kinetics of the heterogeneous catalytic reaction can be adequately expressed by a forward first-order and reverse second-order mechanism. The rate-controlling step with chemically pure 2-propanol is single-site surface reaction, while for the technical grade alcohol the adsorption of alcohol is rate-controlling. The static bed data are compared with the fluidized bed dat

Temperature scaling in a dense vibrofluidized granular material

The leading order "temperature" of a dense two-dimensional granular material fluidized by external vibrations is determined. The grain interactions are characterized by inelastic collisions, but the coefficient of restitution is considered to be close to 1, so that the dissipation of energy during a collision is small compared to the average energy of a particle. An asymptotic solution is obtained where the particles are considered to be elastic in the leading approximation. The velocity distribution is a Maxwell-Boltzmann distribution in the leading approximation,. The density profile is determined by solving the momentum balance equation in the vertical direction, where the relation between the pressure and density is provided by the virial equation of state. The temperature is determined by relating the source of energy due to the vibrating surface and the energy dissipation due to inelastic collisions. The predictions of the present analysis show good agreement with simulation results at higher densities where theories for a dilute vibrated granular material, with the pressure-density relation provided by the ideal gas law, sire in error. [:S1063-651X(99)04408-6].

Measurement of axial dispersion coefficient in a packed bed using X-ray

Dispersion of the liquid in a porous media is of great importance in many areas of engineering and has been studied by several researchers so far. A new experimental method has been developed to measure the dispersion coefficient. X-ray absorption technique provides a better understanding of dispersion that characterizes the mixing phenomenon in the packed beds. This is because the method is non-invasive and also it gives tracer concentration data at every point within the bed. The axial dispersion in a cylindrical bed of non-porous and non-wetting spherical particles has been measured for the flow of water. Aqueous barium chloride solution has been used a as tracer. X-ray images, recorded on a videocassette, have been analyzed using an image processing software to extract the local interstitial velocity and concentration data in the bed. Local dispersion coefficient has been determined with the help of aforementioned data. By using these data, the overall dispersion coefficient in a packed bed can also be estimated.