Ambulatory blood pressure monitoring in the elderly hypertensive patient.

In this retrospective analysis, we assessed the usefulness of ambulatory blood pressure monitoring in the evaluation of elderly hypertensive patients. Thirty-eight untreated and 31 treated hypertensives aged 70 years or more had a systolic blood pressure greater than or equal to 160 mmHg and/or a diastolic blood pressure greater than or equal to 95 mmHg in the clinic. All 69 patients underwent blood pressure monitoring during their customary daily activities using a portable semi-automatic blood pressure recorder (Remier M2000). The mean of all blood pressures obtained with this device was taken as the ambulatory recorded blood pressure. Recorded blood pressures were greater than or equal to 160 mmHg systolic and greater than or equal to 90 mmHg diastolic in 17 untreated and 17 treated patients. In these patients, the introduction of antihypertensive therapy, or its modification, markedly reduced blood pressure during a 4-8 month follow-up. A further 21 untreated and 14 treated patients had recorded blood pressures of less than 160/90 mmHg. The treatment status of these patients was left unchanged for 4-8 months of follow-up. Nevertheless, office blood pressure in these groups, with no change in treatment, decreased significantly during the observation period. At the last visit to the outpatient clinic, there was no significant difference in blood pressure between the four subgroups of patients. Thus, ambulatory blood pressure monitoring appears to be useful in the elderly hypertensive patient in detecting those patients whose blood pressure is elevated only in the clinic. Blood pressure profiles obtained outside the clinic may therefore be useful in making therapeutic decisions in the aged hypertensive.

The Effects of Multifactorial Fall Prevention on the Psychological Risk Factors of Falling

Psychological factors, such as depression or depressive symptoms and fear of falling are linked to falls among the aged. According to previous studies, they may increase the risk of falls and injurious falls. In addition, depression or a high amount of depressive symptoms and fear of falling may hinder participation in preventive activities. Despite the severe consequences of both conditions and their high prevalence among the aged, they have rarely been studied in the context of fall prevention. The study aimed to assess the effects of multifactorial fall prevention on the psychological risk factors of falling (depressive symptoms and fear of falling) among the community-dwelling aged at increased risk of falling. In addition, it aimed to determine factors predicting high adherence to preventive activities. Volunteers aged 65 or over, who had fallen during the year previous to randomisation were recruited. Participants (n=591) were randomised into an intervention or a control group. The intervention group received a multifactorial fall prevention programme including geriatric assessment, individual guidance on fall and fracture prevention, group- and home-based physical exercise, psychosocial group activities, lectures and home hazards assessment. The control group had a one-time counselling on fall and fracture prevention. The data on psychological risk factors of falling were collected by self-rated questionnaires. Multifactorial fall prevention was not effective in reducing depressive symptoms or fear of falling compared to one-time counselling in the total sample. However, in subgroup analyses, depressive symptoms reduced statistically significantly more among the men and older participants of the intervention group compared to the control group. Female gender, high physical and cognitive abilities and low self-perceived probability of falling were independent predictors of higher adherence in organised activities. In conclusion, few psychological benefits were gained during this multifactorial fall prevention trial. More attention should be focused on adherence, especially among the aged with functional disabilities.

Increasing prehospital emergency medical service interventions for nursing home residents.

QUESTION: In the ageing European population, the proportion of interventions by the emergency medical services (EMS) for elderly patients is increasing, but little is known about the recent trend of EMS interventions in nursing homes. The aim of this analysis was to describe the evolution of the incidence of requests for prehospital EMS interventions for nursing home residents aged 65 years and over between 2004 and 2013. METHODS: A prospective population-based register of routinely collected data for each EMS intervention in the Canton of Vaud. Linear time trends of incidence of requests to the EMS in nursing homes were calculated and stratified by age categories. RESULTS: The number of ambulance interventions in nursing homes for people aged 65 years and over (65+) increased by 68.9% (1124‒1898) between 2004 and 2013. A significant linear increase of the annual incidence of requests to EMS per 1,000 nursing home residents was found for people aged 65-79 (10.2, 95% confidence interval [CI] 6.2-14.2), 80-89 (16.5, 95% CI 14.0-19.0) and over 90 (12.1, 95% CI 5.8-18.4). EMS interventions in nursing home residents who required an emergency physician increased during the same period by 205.6% (from 106 to 324), representing an increase from 2% to 7% of all emergency physician interventions in the Canton. CONCLUSIONS: Our results confirmed an important increase in the incidence of EMS interventions in nursing homes during the last decade, far exceeding the actual increase of the nursing home population during the same period. This evolution represents an important opportunity to reconsider the EMS missions in the context of an ageing society.

Neuropeptide Y at the cellular level – Studies on PreproNPY L7P Polymorphism and the Mitochondrial Form of NPY

Neuropeptide Y (NPY) is a widely expressed neurotransmitter in the central and peripheral nervous systems. Thymidine 1128 to cytocine substitution in the signal sequence of the preproNPY results in a single amino acid change where leucine is changed to proline. This L7P change leads to a conformational change of the signal sequence which can have an effect on the intracellular processing of NPY. The L7P polymorphism was originally associated with higher total and LDL cholesterol levels in obese subjects. It has also been associated with several other physiological and pathophysiological responses such as atherosclerosis and T2 diabetes. However, the changes on the cellular level due to the preproNPY signal sequence L7P polymorphism were not known. The aims of the current thesis were to study the effects of the [p.L7]+[p.L7] and the [p.L7]+[p.P7] genotypes in primary cultured and genotyped human umbilical vein endothelial cells (HUVEC), in neuroblastoma (SK-N-BE(2)) cells and in fibroblast (CHO-K1) cells. Also, the putative effects of the L7P polymorphism on proliferation, apoptosis and LDL and nitric oxide metabolism were investigated. In the course of the studies a fragment of NPY targeted to mitochondria was found. With the putative mitochondrial NPY fragment the aim was to study the translational preferences and the mobility of the protein. The intracellular distribution of NPY between the [p.L7]+[p.L7] and the [p.L7]+[p.P7] genotypes was found to be different. NPY immunoreactivity was prominent in the [p.L7]+[p.P7] cells while the proNPY immunoreactivity was prominent in the [p.L7]+[p.L7] genotype cells. In the proliferation experiments there was a difference in the [p.L7]+[p.L7] genotype cells between early and late passage (aged) cells; the proliferation was raised in the aged cells. NPY increased the growth of the cells with the [p.L7]+[p.P7] genotype. Apoptosis did not seem to differ between the genotypes, but in the aged cells with the [p.L7]+[p.L7] genotype, LDL uptake was found to be elevated. Furthermore, the genotype seemed to have a strong effect on the nitric oxide metabolism. The results indicated that the mobility of NPY protein inside the cells was increased within the P7 containing constructs. The existence of the mitochondria targeted NPY fragment was verified, and translational preferences were proved to be due to the origin of the cells. Cell of neuronal origin preferred the translation of mature NPY (NPY1-36) when compared to the non neuronal cells that translated both, NPY and the mitochondrial fragment of NPY. The mobility of the mitochondrial fragment was found to be minimal. The functionality of the mitochondrial NPY fragment remains to be investigated. L7P polymorphism in the preproNPY causes a series of intracellular changes. These changes may contribute to the state of cellular senescence, vascular tone and lead to endothelial dysfunction and even to increased susceptibility to diseases, like atherosclerosis and T2 diabetes.

Effects of 174 G/C polymorphism in the promoter region of the interleukin-6 gene on plasma IL-6 levels and muscle strength in elderly women

We investigated the effect of -174 G/C single-nucleotide polymorphism in the promoter region of the IL6 gene on plasma IL-6 levels and muscle strength, and the relationship between IL-6 levels and muscle strength in elderly women. The sample consisted of 199 elderly residents (73.0 ± 7.8 years old) from rest homes and the community in Belo Horizonte, MG, Brazil. -174 G/C polymorphism was determined by direct sequencing of the product by PCR, and plasma IL-6 concentrations were measured by ELISA. Muscle strength in the knee joint was evaluated using a Biodex System 3 Pro® isokinetic dynamometer. ANCOVA was used to determine the effect of polymorphism on IL-6 levels and muscle strength, and the Pearson correlation coefficient to assess the relationship between IL-6 levels and muscle strength. -174 G/C polymorphism was associated with the plasma IL-6 levels of elderly women (P < 0.01) since homozygotes for the G allele showed high IL-6 levels (GG 3.85 pg/mL, GC + CC 2.13 pg/mL). There was no association of polymorphism on muscle strength (P > 0.05). No association was found between IL-6 levels and knee extensor muscle (r = 0.087, P = 0.306) or flexor (r = -0.011, P = 0.894) strength. An interaction between -174 G/C polymorphism and housing conditions of the sample of elderly women was identified, with the effect of genotype on IL-6 levels being higher in the institutionalized elderly. These results support the evidence that -174 G/C polymorphism of the IL6 gene associates with individual variability of plasma IL-6 levels in elderly women.

Excluding exceptions: Housing non-affordability and the oppression of environmental sustainability?

This paper explores the provision of homes for less wealthy households in rural England. By allowing 'exceptions' to UK planning law to provide low-income housing for local residents, the national government seeks to secure dwellings for the less wealthy and so sustain socially mixed rural villages. This paper explores how the production of homes through the exception policy is not conducive to the construction of many new houses. The particular emphasis in the paper is on how responsible agents are discouraged from being more active in erecting new village homes for low-income households. Empirically, the paper draws on documents, interviews and a social survey in the counties of Bedfordshire, Cambridgeshire and Norfolk to investigate the process of delivering rural exception homes. It is concluded that, despite Government assertions that a socially mixed countryside is desirable, the decision-making criteria that dominate the worldviews of agents in social housing provision work against this outcome. (c) 2005 Elsevier Ltd. All rights reserved.

Chemical, physical and electrical properties of aged dodecylbenzene 3: thermal ageing of mixed isomers in nitrogen and under sealed conditions

Commercial dodecylbenzene cable fluid was aged at temperatures of 105 and 135 degrees C in dry oxygen-free nitrogen. In addition, selected samples were aged at 135 degrees C under sealed conditions where air was excluded from the headspace above the oil. A variety of analytical techniques, such as ultra-violet visible and infra-red spectroscopy, acid number and water content measurements, were then used to characterize the aged oils. In addition, their electrical properties were assessed by dielectric spectroscopy. Compared with ageing in air, the ageing rate was reduced significantly and, as expected, no major oxidation peaks were detected in the infrared spectrometer. Significantly, very little absorbance at 680 nm ("red absorbers") was detected in samples aged with copper and, consequentially, no large increases in dielectric loss were recorded within the ageing times considered here. This study compliments previous investigations on cable fluid and 1-phenyldodecane aged in air and show that the same ageing indicators are valid in oils aged under conditions which more closely resemble those found in high voltage plant.

Chemical, physical and electrical properties of aged dodecylbenzene: thermal ageing of mixed isomers in air

A commercial dodecylbenzene (DDB) cable oil was aged at temperatures between 90 and 135 degrees C in air and was analyzed using various analytical techniques including optical and infra-red spectroscopy and dielectric analysis. On ageing, the oil darkened, significant oxidation features were found by infra-red spectroscopy and the acid number, water content and dielectric loss all increased. Ageing in the presence of paper or aluminum did not affect the ageing process, whereas ageing was significantly modified by the presence of copper. An absorption at 680 nm ("red absorbers") was detected by ultra-violet/visible spectroscopy followed by the production of an opaque precipitate. A reaction between copper and the acid generated on ageing is thought to produce copper carboxylates, and X-ray fluorescence confirmed that copper was indeed present in both the aged oil and the precipitate. Significantly, once red absorbers were detected, the dielectric loss increased to catastrophically high values and, therefore, the appearance of these compounds may serve as a useful diagnostic indicator. The development of acidity on ageing appears to be key in initiating the destructive copper conversion reaction and hence the control of oil acidity may be key to prolonging the life of DDB cable oils.

On the electrical properties of insulation oils

Insulating oils are a major component of high voltage plant, including transformers, switchgear and cables. Consequentially, in terms of plant failure, changes in the electrical characteristics of the oil during ageing are of crucial importance. To address this issue, commercial insulating oil was subjected to controlled ageing under laboratory conditions. The electrical properties of the aged oils were then characterized using dielectric spectroscopy. The data suggest that a degree of electrical conductivity occurs in the aged oils, which reduces the insulating properties of the oil as ageing proceeds. The role of atmosphere and additives on the electrical properties of the oils were also explored. Results are compared with model samples, which contain known amounts of materials that may occur as by-products of the ageing process.

Private investment in the countryside: an assessment of the role of new houses and estates in sustaining the rural economy and environment

The British countryside has been shaped and sustained over the years by the establishment of landed estates. Some of our best known, and now most protected, landmarks derive from this tradition by which money, that was often sourced from outside the rural economy, was invested in land. Whilst there was some reversal in this trend during the last century, there is again a widespread desire among people of means to invest in new country property. Paragraph 3.21 of Planning Policy Guidance Note 7: The Countryside - Environmental Quality and Economic and Social Development was introduced in 1997 as a means of perpetuating the historic tradition of innovation in the countryside through the construction of fine individual houses in landscaped grounds. That it was considered necessary to use a special provision of this kind reflects the prevailing presumption of planning authorities against allowing private residential development in open countryside. The Government is currently reviewing rural planning policy and is focusing on higher density housing, affordable homes and the use of brownfield sites. There is an underlying conception that individual private house developments contribute nothing and are seen as the least attractive option for most development sites. The purpose of paragraph 3.21 lies outside the government’s priorities and its particular provisions may therefore be excluded in forthcoming ‘policy statements’. This paper seeks to examine the role of private investors wishing to build new houses in the countryside, and the impact that that might have on local economies. It explores the interpretation placed on PPG7 through an investigation of appeal sites, and concludes by making recommendations for the review process, including the retention of some form of exceptions policy for new build houses.

An evolutionary innovation perspective on the selection of low and zero carbon technologies in new housing

The Code for Sustainable Homes (the Code) will require new homes in the United Kingdom to be ‘zero carbon’ from 2016. Drawing upon an evolutionary innovation perspective, this paper contributes to a gap in the literature by investigating which low and zero carbon technologies are actually being used by house builders, rather than the prevailing emphasis on the potentiality of these technologies. Using the results from a questionnaire three empirical contributions are made. First, house builders are selecting a narrow range of technologies. Second, these choices are made to minimise the disruption to their standard design and production templates (SDPTs). Finally, the coalescence around a small group of technologies is expected to intensify with solar-based technologies predicted to become more important. This paper challenges the dominant technical rationality in the literature that technical efficiency and cost benefits are the primary drivers for technology selection. These drivers play an important role but one which is mediated by the logic of maintaining the SDPTs of the house builders. This emphasises the need for construction diffusion of innovation theory to be problematized and developed within the context of business and market regimes constrained and reproduced by resilient technological trajectories.

Framing evidence: policy design for the zero carbon home

In 2006 the UK government announced a move to zero carbon homes by 2016. The demand posed a major challenge to policy makers and construction professionals entailing a protracted process of policy design. The task of giving content to this target is used to explore the role of evidence in the policy process. Whereas much literature on policy and evidence treats evidence as an external input, independent of politics, this paper explores the ongoing mutual constitution of both. Drawing on theories of policy framing and the sociology of classification, the account follows the story of a policy for Zero Carbon Homes from the parameters and values used to specify the target. Particular attention is given to the role of Regulatory Impact Assessments (RIAs) and to the creation of a new policy venue, the Zero Carbon Hub. The analysis underlines the way in which the choices about how to model and measure the aims potentially transforms them, the importance of policy venues for transparency and the role of RIAs in the authorization of particular definitions. A more transparent, open approach to policy formulation is needed in which the framing of evidence is recognized as an integral part of the policy process.

The fractured lives of German Bohemian children, born 1933-40 in the area known as Sudetenland: a memory study, Nablonz-Neugablonz

At the Paris Peace Conferences of 1918-1919, new states aspiring to be nation-states were created for 60 million people, but at the same time 25 million people found themselves as ethnic minorities. This change of the old order in Europe had a considerable impact on one such group, more than 3 million Bohemian German-speakers, later referred to as Sudeten Germans. After the demise of the Habsburg Empire In 1918, they became part of the new state of Czechoslovakia. In 1938, the Munich Agreement – prelude to the Second World War – integrated them into Hitler’s Reich; in 1945-1946 they were expelled from the reconstituted state of Czechoslovakia. At the centre of this War Child case study are German children from the Northern Bohemian town and district, formerly known as Gablonz an der Neisse, famous for exquisite glass art, now Jablonec nad Nisou in the Czech Republic. After their expulsion they found new homes in the post-war Federal Republic of Germany. In addition, testimonies have been drawn upon of some Czech eyewitnesses from the same area, who provided their perspective from the other side, as it were. It turned out to be an insightful case study of the fate of these communities, previously studied mainly within the context of the national struggle between Germans and Czechs. The inter-disciplinary research methodology adopted here combines history and sociological research to demonstrate the effect of larger political and social developments on human lives, not shying away from addressing sensitive political and historical issues, as far as these are relevant within the context of the study. The expellees started new lives in what became Neugablonz in post-war Bavaria where they successfully re-established the industries they had had to leave behind in 1945-1946. Part 1 of the study sheds light on the complex Czech-German relationship of this important Central European region, addressing issues of democracy, ethnicity, race, nationalism, geopolitics, economics, human geography and ethnography. It also charts the developments leading to the expulsion of the Sudeten Germans from Czechoslovakia after 1945. What is important in this War Child study is how the expellees remember their history while living as children in Sudetenland and later. The testimony data gained indicate that certain stereotypes often repeated within the context of Sudeten issues such as the confrontational nature of inter-ethnic relations are not reflected in the testimonies of the respondents from Gablonz. In Part 2 the War Child Study explores the memories of the former Sudeten war children using sociological research methods. It focuses on how they remember life in their Bohemian homeland and coped with the life-long effects of displacement after their expulsion. The study maps how they turned adversity into success by showing a remarkable degree of resilience and ingenuity in the face of testing circumstances due to the abrupt break in their lives. The thesis examines the reasons for the relatively positive outcome to respondents’ lives and what transferable lessons can be deduced from the results of this study.

Detecting defects in the UK new-build housing sector: a learning perspective

Rapid growth in the production of new homes in the UK is putting build quality under pressure as evidenced by an increase in the number of defects. Housing associations (HAs) contribute approximately 20% of the UK’s new housing supply. HAs are currently experiencing central government funding cuts and rental revenue reductions. As part of HAs’ quest to ramp up supply despite tight budget conditions, they are reviewing how they learn from defects. Learning from defects is argued as a means of reducing the persistent defect problem within the UK housebuilding industry, yet how HAs learn from defects is under-researched. The aim of this research is to better understand how HAs, in practice, learn from past defects to reduce the prevalence of defects in future new homes. The theoretical lens for this research is organizational learning. The results drawn from 12 HA case studies indicate that effective organizational learning has the potential to reduce defects within the housing sector. The results further identify that HAs are restricting their learning to focus primarily on reducing defects through product and system adaptations. Focusing on product and system adaptations alone suppresses HAs’ abilities to reduce defects in the future.

PHYSICAL AND CHEMICAL CHARACTERISTICS OF FROZEN GROUND BEEF AND AGED BEEF MEAT FROM BOS INDICUS STEERS SUPPLEMENTED WITH alpha-TOCOPHEROL ACETATE

The objective of this study was to evaluate the effects of diet supplementation with vitamin E on the physical and chemical characteristics of ground, frozen and stored or aged Quadriceps femoris (QF) and Longissimus dorsi (LD) muscles from Nellore steers fed high concentrate diets. Muscles were obtained from 24 animals that were 30 months old with a mean live weight of 279 kg. Half of the animals received daily doses of 1,000 mg of alpha-tocopherol acetate (VIT E) per head per day that was added to 100 g of corn meal. The other half received 100 g of corn meal without the antioxidant. Twenty-four hours after slaughtering, QF samples from each animal were ground, frozen and stored for up to 6 months. In addition, 4 samples from the LD of each animal were vacuum packed individually and kept for 21 days. All samples were analyzed to determine the pH, color and water-holding-capacity. The VIT E supplementation improved only the water loss characteristics of frozen ground QF and did not have any positive effect on the physical-chemical characteristics of the aged LD.