The influence of market deregulation on fast food consumption and body mass index:A cross-national time series analysis

Objective
To investigate the effect of fast food consumption on mean population body mass index (BMI) and explore the possible influence of market deregulation on fast food consumption and BMI.

Methods
The within-country association between fast food consumption and BMI in 25 high-income member countries of the Organisation for Economic Co-operation and Development between 1999 and 2008 was explored through multivariate panel regression models, after adjustment for per capita gross domestic product, urbanization, trade openness, lifestyle indicators and other covariates. The possible mediating effect of annual per capita intake of soft drinks, animal fats and total calories on the association between fast food consumption and BMI was also analysed. Two-stage least squares regression models were conducted, using economic freedom as an instrumental variable, to study the causal effect of fast food consumption on BMI.

Findings
After adjustment for covariates, each 1-unit increase in annual fast food transactions per capita was associated with an increase of 0.033 kg/m2 in age-standardized BMI (95% confidence interval, CI: 0.013–0.052). Only the intake of soft drinks – not animal fat or total calories – mediated the observed association (β: 0.030; 95% CI: 0.010–0.050). Economic freedom was an independent predictor of fast food consumption (β: 0.27; 95% CI: 0.16–0.37). When economic freedom was used as an instrumental variable, the association between fast food and BMI weakened but remained significant (β: 0.023; 95% CI: 0.001–0.045).

Conclusion
Fast food consumption is an independent predictor of mean BMI in high-income countries. Market deregulation policies may contribute to the obesity epidemic by facilitating the spread of fast food.

Calculated and observed long term performance of Leneghans embankment

This paper presents the finite element (FE) analysis of the consolidation of the foundation of an embankment constructed over soft clay deposit which shows significant time dependent behaviour and was improved with prefabricated vertical drains. To assess the capability of a simple elastic viscoplastic (EVP) model to predict the long term performance of a geotechnical structure constructed on soft soils, a well documented (Leneghans) embankment was analyzed to predict its long term behaviour characteristics. Two fully coupled two dimensional (2D) plane strain FE analyses have been carried out. In one of these, the foundation of the embankment was modelled with a relatively simpler time dependent EVP model and in the other one, for comparison purposes, the foundation soil was modelled with elasto-plastic Modified Cam-clay (MCC) model. Details of the analyses and the results are discussed in comparison with the field performance. Predictions from the creep (EVP) model were found to be better than those from Elasto-plastic (MCC) analysis. However, the creep analysis requires an additional parameter and additional computational time and resources. © 2011 Taylor & Francis.

Effect of geosynthetic reinforcement creep on the long term performance of an embankment

Geo-synthetic reinforcements are often used to enhance the stability of geotechnical structures such as embankments. These geosynthetic polymers often show significant creep deformational behaviour. In the short-term performance of a geotechnical structure, it may not play a significant role. However, while dealing with the long term behaviour, it is necessary to investigate its effect. In this paper two plane strain fully coupled finite element analysis have been conducted; one with and the other without taking into account of the creep behaviour of geosynthetics. A well documented field case of Leneghans embankment (Geogrid improved wide embankment constructed near Sydney, Australia in 1990s) have been used for this purpose. It is evident from the analyses that though the geosynthetic reinforcements may play a vital role in the performance/stability of an embankment in the early days (during and after construction), its contribution may become insignificant with time and the creep of geo-synthetic may not play a significant role in the long term stability. © 2012 American Society of Civil Engineers.

Stiffness analysis of polymeric composites using the finite element method

The ability to predict the mechanical behavior of polymer composites is crucial for their design and manufacture. Extensive studies based on both macro- and micromechanical analyses are used to develop new insights into the behavior of composites. In this respect, finite element modeling has proved to be a particularly powerful tool. In this article, we present a Galerkin scheme in conjunction with the penalty method for elasticity analyses of different types of polymer composites. In this scheme, the application of Green's theorem to the model equation results in the appearance of interfacial flux terms along the boundary between the filler and polymer matrix. It is shown that for some types of composites these terms significantly affect the stress transfer between polymer and fillers. Thus, inclusion of these terms in the working equations of the scheme preserves the accuracy of the model predictions. The model is used to predict the most important bulk property of different types of composites. Composites filled with rigid or soft particles, and composites reinforced with short or continuous fibers are investigated. For each case, the results are compared with the available experimental results and data obtained from other models reported in the literature. Effects of assumptions made in the development of the model and the selection of the prescribed boundary conditions are discussed.

The origin of high activity but low CO2 selectivity on binary PtSn in the direct ethanol fuel cell

The most active binary PtSn catalyst for direct ethanol fuel cell applications has been studied at 20 ^oC and 60 ^oC, using variable temperature electrochemical in-situ FTIR. In comparison with Pt, binary PtSn inhibits ethanol dissociation to CO(a), but promotes partial oxidation to acetaldehyde and acetic acid. Increasing the temperature from 20 ^oC to 60 ^oC facilitates both ethanol dissociation to CO(a) and their further oxidation to CO₂, leading to an increased selectivity towards CO₂; however, acetaldehyde and acetic acid are still the main products. Potential-dependent phase diagrams for surface oxidants of OH(a) formation on Pt(111), Pt(211) and Sn modified Pt(111) and Pt(211) surfaces have been determined using density functional theory (DFT) calculations. It is shown that Sn promotes the formation of OH(a) with a lower onset potential on the Pt(111) surface, whereas an increase in the onset potential is found on modification of the (211) surface. In addition, Sn inhibits the Pt(211) step edge with respect to ethanol C-C bond breaking compared with that found on the pure Pt, which reduces the formation of CO(a). Sn was also found to facilitate ethanol dehydrogenation and partial oxidation to acetaldehyde and acetic acid which, combined with the more facile OH(a) formation on the Pt(111) surface, gives us a clear understanding of the experimentally determined results. This combined electrochemical in-situ FTIR and DFT study, provides, for the first time, an insight into the long-term puzzling features of the high activity but low CO₂ production found on binary PtSn ethanol fuel cell catalysts.

A Pilot Evaluation of the Palliative Performance Scale in Long Term Care: Tips for Success

Aims: Palliative care in long-term care (LTC) homes is an area of growing concern. Little work has been done to explore innovative ways to identify and care for residents who become palliative. The purpose of this intervention study was to evaluate the implementation of the Palliative Performance Scale (PPS) in LTC. Specifically we explored staff perceptions about implementing the PPS and how it cued staff to initiate palliative care discussion with residents and family when a resident’s health declined.

Methods: This study utilized a qualitative descriptive design that included data from four separate sources: journals of three ‘champions’ who were responsible for leading the implementation of the PPS; staff evaluations of three educational training sessions; minutes from meetings; and 11 interviews from key staff who were involved in the implementation process. Data were analyzed using thematic content analysis.

Results: Staff generally felt positively about using the PPS in LTC and stated that it increased awareness of palliative care and helped identify those residents who were nearing the end of life. There were some barriers to implementing it, such as staff resistance and lack of time to complete it. The importance of having a designated ‘champion’ and effective interdisciplinary communication in addition to widespread training, were identified as successful strategies to facilitate the implementation process.

Conclusion: These study findings support the use of the PPS in LTC and offer some perspective about ways to implement it successfully. Future work is needed to evaluate the PPS in LTC using more rigorous designs.

Perceptions of the Nurse Practitioner Role in Facilitating the Implementation of an Onsite Pain Management Team in Long Term Care

Background: One strategy to improve pain management in long term care (LTC) is to optimize the emerging role of the nurse practitioner (NP) in LTC. The purpose of this sub study was to learn about the NP role in implementing an onsite, interdisciplinary Pain Team in the LTC home setting.

Methods: We used a case study design that included two NPs who worked at separate LTC homes. Each of the NPs completed a weekly questionnaire of pain-related activities that they engaged in over a one-year implementation period; and a diary, using critical reflection, about their experiences and strategies used to implement the Pain Team. Descriptive statistics and thematic content analysis were used to analyze the case study data.

Findings: NPs tended to be most engaged in pain assessment and collaborated more with licensed nurses and personal support workers; less with pharmacists. NPs were more involved in organizational level activities, such as participating in committee work or assisting with the development of policies and procedures about pain. NPs created palliative care and pain service protocols; engaged in policy development, in-servicing, quality assurance and advocacy; and encouraged best practices. NPs were challenged with time constraints for pain management and balancing other role priorities and felt that increased scope of practice for them was needed.

Conclusions: The results of this study highlight how NPs implemented a Pain Team in LTC which may be helpful to others interested in implementing a similar strategy to reduce residents’ pain.

Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States

Objective: To investigate the association between serum 25-hydroxyvitamin D concentrations (25(OH)D) and mortality in a large consortium of cohort studies paying particular attention to potential age, sex, season, and country differences.

Design: Meta-analysis of individual participant data of eight prospective cohort studies from Europe and the US.

Setting: General population.

Participants: 26 018 men and women aged 50-79 years

Main outcome measures: All-cause, cardiovascular, and cancer mortality.

Results: 25(OH)D concentrations varied strongly by season (higher in summer), country (higher in US and northern Europe) and sex (higher in men), but no consistent trend with age was observed. During follow-up, 6695 study participants died, among whom 2624 died of cardiovascular diseases and 2227 died of cancer. For each cohort and analysis, 25(OH)D quintiles were defined with cohort and subgroup specific cut-off values. Comparing bottom versus top quintiles resulted in a pooled risk ratio of 1.57 (95% CI 1.36 to 1.81) for all-cause mortality. Risk ratios for cardiovascular mortality were similar in magnitude to that for all-cause mortality in subjects both with and without a history of cardiovascular disease at baseline. With respect to cancer mortality, an association was only observed among subjects with a history of cancer (risk ratio, 1.70 (1.00 to 2.88)). Analyses using all quintiles suggest curvilinear, inverse, dose-response curves for the aforementioned relationships. No strong age, sex, season, or country specific differences were detected. Heterogeneity was low in most meta-analyses.

Conclusions: Despite levels of 25(OH)D strongly varying with country, sex, and season, the association between 25(OH)D level and all-cause and cause-specific mortality was remarkably consistent. Results from a long term randomised controlled trial addressing longevity are being awaited before vitamin D supplementation can be recommended in most individuals with low 25(OH)D levels.

The nucleus of Comet 67P/Churyumov-Gerasimenko. A new shape model and thermophysical analysis

Context. Comet 67P/Churyumov-Gerasimenko is the target of the European Space Agency Rosetta spacecraft rendez-vous mission. Detailed physical characteristation of the comet before arrival is important for mission planning as well as providing a test bed for ground-based observing and data-analysis methods. Aims: To conduct a long-term observational programme to characterize the physical properties of the nucleus of the comet, via ground-based optical photometry, and to combine our new data with all available nucleus data from the literature. Methods: We applied aperture photometry techniques on our imaging data and combined the extracted rotational lightcurves with data from the literature. Optical lightcurve inversion techniques were applied to constrain the spin state of the nucleus and its broad shape. We performed a detailed surface thermal analysis with the shape model and optical photometry by incorporating both into the new Advanced Thermophysical Model (ATPM), along with all available Spitzer 8-24 μm thermal-IR flux measurements from the literature. Results: A convex triangular-facet shape model was determined with axial ratios b/a = 1.239 and c/a = 0.819. These values can vary by as much as 7% in each axis and still result in a statistically significant fit to the observational data. Our best spin state solution has Psid = 12.76137 ± 0.00006 h, and a rotational pole orientated at Ecliptic coordinates λ = 78°(±10°), β = + 58°(±10°). The nucleus phase darkening behaviour was measured and best characterized using the IAU HG system. Best fit parameters are: G = 0.11 ± 0.12 and HR(1,1,0) = 15.31 ± 0.07. Our shape model combined with the ATPM can satisfactorily reconcile all optical and thermal-IR data, with the fit to the Spitzer 24 μm data taken in February 2004 being exceptionally good. We derive a range of mutually-consistent physical parameters for each thermal-IR data set, including effective radius, geometric albedo, surface thermal inertia and roughness fraction. Conclusions: The overall nucleus dimensions are well constrained and strongly imply a broad nucleus shape more akin to comet 9P/Tempel 1, rather than the highly elongated or "bi-lobed" nuclei seen for comets 103P/Hartley 2 or 8P/Tuttle. The derived low thermal inertia of

Empirical testing of genuine savings as an indicator of weak sustainability: a three-country analysis of long run trends

Genuine Savings has emerged as a widely-used indicator of sustainable development. In this paper, we use long-term data stretching back to 1870 to undertake empirical tests of the relationship between Genuine Savings (GS) and future well-being for three countries: Britain, the USA and Germany. Our tests are based on an underlying theoretical relationship between GS and changes in the present value of future consumption. Based on both single country and panel results, we find evidence supporting the existence of a cointegrating (long run equilibrium) relationship between GS and future well-being, and fail to reject the basic theoretical result on the relationship between these two macroeconomic variables. This provides some support for the GS measure of weak sustainability. We also show the effects of modelling shocks, such as World War Two and the Great Depression.

Processing, microstructure and mechanical properties of air plasma-sprayed ceria-yttria co-stabilized zirconia coatings

Thermal barrier coatings (TBCs) are widely adopted to protect mechanical components in gas turbine engines operating at high temperature. Basically, the surface temperature of these components must be low enough to retain material properties within acceptable bounds and to extend component life. From this standpoint, air plasma-sprayed (APS) ceria and yttria co-stabilized zirconia (CYSZ) is particularly promising because it provides enhanced thermal insulation capabilities and resistance to hot corrosion. However, essential mechanical properties, such as hardness and Young's modulus, have been less thoroughly investigated. Knowledge of Young's modulus is of concern because it has a significant effect on strain tolerance and stress level and, hence, on durability. The focus of the present study was to determine the mechanical properties of APS CYSZ coatings. In particular, X-ray diffraction (XRD) is adopted for phase analysis of powders and as-sprayed coatings. In addition, scanning electron microscopy (SEM) and image analysis (IA) are employed to explore coating microstructure and porosity. Finally, the Young's modulus of the coating is determined using nanoindentation and a resonant method. The results obtained are then discussed and a cross-check on their consistency is carried out by resorting to a micromechanical model. © 2010 Blackwell Publishing Ltd.

Building capacity in palliative care for personal support workers in long-term care through experiential learning

Background

Providing palliative care in long-term care (LTC) homes is an area of growing importance. As a result, attention is being given to exploring effective palliative care learning strategies for personal support workers (PSWs) who provide the most hands-on care to LTC residents.

The purpose of this intervention was to explore hospice visits as an experiential learning strategy to increase the capacity of PSWs in palliative care, specifically related to their new learning, and how they anticipated this experience changed their practices in LTC.

This study utilised a qualitative descriptive design.

Eleven PSWs from four Ontario LTC homes were sent to their local hospice to shadow staff for one to two days. After the visit, PSWs completed a questionnaire with open-ended questions based on critical reflection. Data were analysed using thematic content analysis.

PSWs commented on the extent of resident-focused care at the hospice and how palliative care interventions were tailored to meet the needs of residents. PSWs were surprised with the lack of routine at the hospice but felt that hospice staff prioritised their time effectively in order to meet family and client care needs. Some PSWs were pleased to see how well integrated the PSW role is on the community hospice team without any hierarchical relationships. Finally, PSWs felt that other LTC staff would benefit from palliative care education and becoming more comfortable with talking about death and dying with other staff, residents and family members.

This study highlighted the benefits of PSWs attending a hospice as an experiential learning strategy. Future work is needed to evaluate this strategy using more rigorous designs as a way to build capacity within PSWs to provide optimal palliative care for LTC residents and their family members.

PSWs need to be recognised as important members within the interdisciplinary team. PSWs who shadow staff at hospices view this experience as a positive strategy to meet their learning needs related to palliative care.

Streptococcus bovis bacteraemia: an evaluation of the long-term effect on cardiac outcomes

Introduction: Streptococcus bovis can lead to bacteraemia, septicaemia, and ultimately endocarditis. The objective of this study was to evaluate the long-term implications of S. bovis endocarditis on cardiac morbidity and mortality. 

Methods: A retrospective cohort study was performed between January 2000 and March 2009 to assess all patients diagnosed with S. bovis bacteraemia from the Belfast Health and Social Care Trust. The primary end-point for cardiac investigations was the presence of endocarditis. Secondary end-points included referral for cardiac surgery and overall mortality. 

Results: Sixty-one positive S. bovis blood cultures from 43 patients were included. Following echocardiography, seven patients were diagnosed with infective endocarditis (16.3 % of total patients); four patients (9.3 %) had native valve involvement while three (7.0 %) had prosthetic valve infection. Five of these seven patients had more than one positive S. bovis culture (71.4 %). Three had significant valve dysfunction that warranted surgical repair/replacement, one of whom was unfit for surgery. There was a 100 % recurrence rate amongst the valve replacement patients (n = 2) and six patients with endocarditis had colorectal pathology. Patients with endocarditis had similar long-term survival as those with non-endocarditic bacteraemia (57.1 % alive vs. 50 % of non-endocarditis patients, p = 0.73). 

Conclusion: Streptococcus bovis endocarditis patients tended to have pre-existing valvular heart disease and those with prosthetic heart valves had higher surgical intervention and relapse rates. These patients experienced a higher rate of co-existing colorectal pathology but currently have reasonable long-term outcomes. This may suggest that they represent a patient population that merits consideration for an early surgical strategy to maximise long-term results, however, further evaluation is warranted. © 2013 The Japanese Association for Thoracic Surgery.

Estimating the incidence, prevalence and true cost of asthma in the UK: Secondary analysis of national stand-alone and linked databases in England, Northern Ireland, Scotland and Wales-a study protocol

Introduction Asthma is now one of the most common long-term conditions in the UK. It is therefore important to develop a comprehensive appreciation of the healthcare and societal costs in order to inform decisions on care provision and planning. We plan to build on our earlier estimates of national prevalence and costs from asthma by filling the data gaps previously identified in relation to healthcare and broadening the field of enquiry to include societal costs. This work will provide the first UK-wide estimates of the costs of asthma. In the context of asthma for the UK and its member countries (ie, England, Northern Ireland, Scotland and Wales), we seek to: (1) produce a detailed overview of estimates of incidence, prevalence and healthcare utilisation; (2) estimate health and societal costs; (3) identify any remaining information gaps and explore the feasibility of filling these and (4) provide insights into future research that has the potential to inform changes in policy leading to the provision of more cost-effective care.

Methods and analysis Secondary analyses of data from national health surveys, primary care, prescribing, emergency care, hospital, mortality and administrative data sources will be undertaken to estimate prevalence, healthcare utilisation and outcomes from asthma. Data linkages and economic modelling will be undertaken in an attempt to populate data gaps and estimate costs. Separate prevalence and cost estimates will be calculated for each of the UK-member countries and these will then be aggregated to generate UK-wide estimates.

Ethics and dissemination Approvals have been obtained from the NHS Scotland Information Services Division's Privacy Advisory Committee, the Secure Anonymised Information Linkage Collaboration Review System, the NHS South-East Scotland Research Ethics Service and The University of Edinburgh's Centre for Population Health Sciences Research Ethics Committee. We will produce a report for Asthma-UK, submit papers to peer-reviewed journals and construct an interactive map.