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The extent of anticholinergic burden across an older Welsh population living with frailty: Cross-sectional analysis of general practice records
Get PDFYesAnticholinergic medicines are associated with adverse outcomes for older people. However, little is known about their use in frailty. The objectives were to (1) investigate the prevalence of anticholinergic prescribing for older patients, and (2) examine anticholinergic burden according to frailty status.
Methods: Cross-sectional analysis of Welsh primary care data from the Secure Anonymised Information Linkage (SAIL) databank including patients aged ≥65 at their first GP consultation between 1st January and 31st December 2018. Frailty was identified using the electronic Frailty Index (eFI) and anticholinergic burden using the Anticholinergic Cognitive Burden (ACB) scale. Descriptive analysis and logistic regression were conducted to 1) describe the type and frequency of anticholinergics prescribed; 2) to estimate the association between frailty and cumulative ACB score (ACB-Sum).
Results: In this study of 529,095 patients, 47.4% of patients receiving any prescription medications were prescribed at least one anticholinergic medicine. Adjusted regression analysis showed that patients with increasing frailty had higher odds of having an ACB-Sum of >3 compared to patients who were fit (mild frailty, adj OR 1.062 (95%CI 1.061–1.064), moderate frailty, adj OR 1.134 (95%CI 1.131–1.136), severe frailty, adj OR 1.208 (95%CI 1.203–1.213)).
Conclusions: Anticholinergic prescribing was high in this older population. Older people with advancing frailty are exposed to the highest anticholinergic burden despite being the most vulnerable to the associated adverse effects. Older people with advancing frailty should be considered for medicines review to prevent overaccumulation of anticholinergic medications given the risks of functional and cognitive decline that frailty presents.NIHRResearch Development Fund Publication Prize Award winner, May 2023
Computer modelling of compact 28/38 GHz dual-band antenna for millimeter-wave 5G applications
Get PDFYesA four-element compact dual-band patch antenna having a common ground plane operating at 28/38 GHz is proposed for millimeter-wave communication systems in this paper. The multiple-input-multiple-output (MIMO) antenna geometry consists of a slotted ellipse enclosed within a hollow circle which is orthogonally rotated with a connected partial ground at the back. The overall size of the four elements MIMO antenna is 2.24λ × 2.24λ (at 27.12 GHz). The prototype of four-element MIMO resonator is designed and printed using Rogers RT Duroid 5880 with εr = 2.2 and loss tangent = 0.0009 and having a thickness of 0.8 mm. It covers dual-band having a fractional bandwidth of 15.7% (27.12-31.34 GHz) and 4.2% (37.21-38.81 GHz) for millimeter-wave applications with a gain of more than 4 dBi at both bands. The proposed antenna analysis in terms of MIMO diversity parameters (Envelope
Correlation Coefficient (ECC) and Diversity Gain (DG)) is also carried out. The experimental result in terms of
reflection coefficient, radiation pattern, gain and MIMO diversity parameter correlates very well with the simulated
ones that show the potential of the proposed design for MIMO applications at millimeter-wave frequencies.Moore4Medical Project; ECSEL JU in collaboration with the EU H2020 Framework Programme (H2020/2014-2020) under Grant Agreement H2020-ECSEL-2019-IA-876190, and Fundação para a Ciência e Tecnologia (ECSEL/0006/2019); FCT/MEC; ERDF under the PT2020 Partnership Agreement under the UID/EEA/50008/2020 Project
Risk factors of diarrhoea among under-five children in Zimbabwe: A systematic review
Get PDFYesChildren are at a higher risk of succumbing to diarrhoea. Zimbabwe remains one of the countries topping in terms of morbidity and mortality due to diarrhoea diseases among under-fives. This study aims to determine factors affecting diarrhoea among under-five children in Zimbabwe.
Methodology: A systematic review was executed based on searches from six databases. All types of studies published between 2018 and 2022 in English about diarrhoea disease and among children under the age of five in Zimbabwe were included. Seventeen articles met the requirements of this study. All the data was inputted onto a data extraction sheet and thematic analysis was carried out on the study outcomes to identify themes.
Results: Diarrhoea risk factors can be categorized into two main themes; modifiable and non-modifiable diarrhoea risk factors. Under the modifiable risk factors are four subthemes: environmental, socio-economic, behavioural, and modifiable biological diarrhoea risk factors. Under the non-modifiable risk factors are two sub-themes: age and gender. For any Water, Hygiene and Sanitation (WASH) intervention to succeed, these risk factors should be present at optimum. If any of the factors is not optimally present, WASH interventions must concurrently address the risk factor or else the intervention is predestined to fail.
Conclusion: WASH remains an important issue in Zimbabwe as a tool to improve the lives of children under five years old. There is a necessity to investigate why certain interventions work well in other low-income countries and not Zimbabwe. All WASH interventions must make a thorough baseline assessment of conditions present on the ground to ensure the success of interventions
The precariousness of living with, and caring for people with, dementia: Insights from the IDEAL programme
Get PDFYesThis paper uses precarity as a framework to understand the vulnerabilities experienced by those living with or caring for someone living with dementia. Drawing on qualitative interview data from the Improving the Experience of Dementia and Enhancing Active Life (IDEAL) programme, we attend to our participants' reflections on how they manage the condition and the wider circumstances in which this occurs. To interrogate the utility of precarity, we focus on our participants' descriptions of needs and challenges and set these alongside both the wider contexts in which they seek or offer care (formal and informal) and the sets of values attributed to different ways of living with dementia. Building on the work of Portacolone, our analysis identified four interconnected themes: uncertainty; experiences of support and services; independence and personhood; and cumulative pressures and concerns. We develop this analysis by reviewing how our themes reflect, extend, or depart from previously identified markers of precarity and consider the specific ways in which these markers shape the lives of those living with dementia.‘Improving the experience of Dementia and Enhancing Active Life: living well with dementia. The IDEAL study’ was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) through grant ES/L001853/2. ESRC is part of UK Research and Innovation (UKRI). ‘Improving the experience of Dementia and Enhancing Active Life: a longitudinal perspective on living well with dementia. The IDEAL-2 study’ is funded by Alzheimer’s Society, grant number 348, AS-PR2-16-001
Predictors of knowledge, attitude, and practice (KAP) towards family planning (FP) among pregnant women in Fiji
Get PDFYesThis study aimed to determine the predictors of Knowledge, Attitude and Practice (KAP) towards Family Planning (FP) among pregnant Fijian women.
A cross-sectional study was conducted over two months in 2019 with adult pregnant women attending the Antenatal Clinic (ANC) at Ba Mission Hospital (BMH), Fiji. Data was collected using a self-administrated questionnaire. Statistical analysis included correlation tests and regression analysis in determining predictors of KAP.
240 pregnant women participated in this study with a mean age of 26.02 (± SD = 4.13). The results showed a moderate level of knowledge (mean 14.95, SD ± 3.15), positive attitude (mean 20.56, SD ± 5.68), and good practice (mean 4.97, SD ± 1.73). Linear regression identified that women with more than seven children had a knowledge score of 3.65, lower than null parity (t value = -2.577, p = 0.011). Women aged 20 to 24 had a 6.47 lower attitude score than women aged 18 to 19 (t value = -2.142, p = 0.033). Women in defacto relationships had a 2.12 lower attitude score compared to the married category (t value = -2.128, p = 0.034). Fijian women of Indian descent had a 1.98 lower attitude score than the I Taukei women (t value = -2.639, p = 0.009). Women aged 30-34 had 2.41 lower practice scores than those aged 18-19 (t value = -2.462, p = 0.015).
This study found a medium knowledge of FP among pregnant women. These findings support a recommendation for further research to implement effective strategies
Development and Validation of a Brief Version of the Vanderbilt Fatigue Scale for Adults: The VFS-A-10
Get PDFYesObjectives: Listening-related fatigue can be a significant problem for adults who struggle to
hear and understand, particularly adults with hearing loss. However, valid, sensitive, and
clinically useful measures for listening-related fatigue do not currently exist. The purpose of this
study was to develop and validate a brief clinical tool for measuring listening-related fatigue in
adults.
Design: The clinical scale was derived from the 40-item version of the Vanderbilt Fatigue Scale
for Adults (VFS-A-40), an existing, reliable, and valid research tool for measuring listening9 related fatigue. The study consisted of two phases. Phase 1 (N = 580) and Phase 2 (N = 607)
participants consisted of convenience samples of adults recruited via online advertisements,
clinical records review, and a pool of prior research participants. In Phase 1, results from item
response theory (IRT) analyses of VFS-A-40 items were used to identify high quality items for
the brief (10-item) clinical scale: the VFS-A-10. In Phase 2, the characteristics and quality of the
VFS-A-10 were evaluated in a separate sample of respondents. Dimensionality was evaluated
using exploratory factor analyses (EFA) and item quality and characteristics were evaluated
using IRT. VFS-A-10 reliability and validity were assessed multiple ways. IRT reliability
analysis was used to examine VFS-A-10 measurement fidelity. In addition, test-retest reliability
was assessed in a subset of Phase 2 participants (n = 145) who completed the VFS-A-10 a
second time approximately one month after their initial measure (range 5-90 days). IRT
differential item functioning (DIF) was used to assess item bias across different age, gender, and
hearing loss subgroups. Convergent construct validity was evaluated by comparing VFS-A-10
responses to two other generic fatigue scales and a measure of hearing disability. Known-groups validity was assessed by comparing VFS-A-10 scores between adults with and without self reported hearing loss
Results: EFA suggested a unidimensional structure for the VFS-A-10. IRT analyses confirmed
all test items were high quality. IRT reliability analysis revealed good measurement fidelity over
a wide range of fatigue severities. Test-retest reliability was excellent (rs = .88, collapsed across
participants). IRT DIF analyses confirmed the VFS-A-10 provided a valid measure of listening29 related fatigue regardless of respondent age, gender, or hearing status. An examination of
associations between VFS-A-10 scores and generic fatigue/vigor measures revealed only weak31 to-moderate correlations (Spearman’s correlation coefficient rs = -.36 to .57). Stronger
associations were seen between VFS-A-10 scores and a measure of perceived hearing difficulties
(rs = .79 to .81) providing evidence of convergent construct validity. In addition, the VFS-A-10
was more sensitive to fatigue associated with self-reported hearing difficulties than generic
measures. It was also more sensitive than generic measures to variations in fatigue as a function
of degree of hearing impairment.
Conclusions: These findings suggest that the VFS-A-10 is a reliable, valid, and sensitive tool for
measuring listening-related fatigue in adults. Its brevity, high sensitivity, and good reliability
make it appropriate for clinical use. The scale will be useful for identifying those most affected
by listening-related fatigue and for assessing benefits of interventions designed to reduce its
negative effects.Starkey Inc, NIH National Institute on Deafness and Other Communication Disorders (NIDCD) Grant #R21DC012865, NICHD Grant P30HD15052 to the Vanderbilt Kennedy Center for Research on Human Development, Vanderbilt Institute for Clinical and Translational Research grant (UL1 TR000445 from NCATS/NIH
Rethinking Transphobia in the UK: What's Wrong with Rights?
Get PDFYesWhat’s wrong with human rights discourse and equality legislation is their creation under the guise of neutrality. The practice of human rights and equality sit within administration systems that are in general sites of production and implementation of racism, homophobia, xenophobia, sexism, transphobia and ableism. Whilst the people subject to these types of discrimination fight hard and make sacrifices to win the inclusion of their rights, whilst such privileges sit within archaic systems - can they ever be anything more than a temporary respite from oppression not a resolution
Teaching open and reproducible scholarship: a critical review of the evidence base for current pedagogical methods and their outcomes.
Get PDFYesIn recent years, the scientific community has called for improvements in the credibility, robustness and reproducibility of research, characterized by increased interest and promotion of open and transparent research practices. While progress has been positive, there is a lack of consideration about how this approach can be embedded into undergraduate and postgraduate research training. Specifically, a critical overview of the literature which investigates how integrating open and reproducible science may influence student outcomes is needed. In this paper, we provide the first critical review of literature surrounding the integration of open and reproducible scholarship into teaching and learning and its associated outcomes in students. Our review highlighted how embedding open and reproducible scholarship appears to be associated with (i) students' scientific literacies (i.e. students' understanding of open research, consumption of science and the development of transferable skills); (ii) student engagement (i.e. motivation and engagement with learning, collaboration and engagement in open research) and (iii) students' attitudes towards science (i.e. trust in science and confidence in research findings). However, our review also identified a need for more robust and rigorous methods within pedagogical research, including more interventional and experimental evaluations of teaching practice. We discuss implications for teaching and learning scholarship.UKRI/ESRC rapid call grant, ealth Research Board Applying Researchinto Policy and Practice Fellowship, John Templeton Foundation (grant ID: 62631), Northern Ireland Department for the Economy Research Studentshi
Dynamic modelling and simulation of industrial scale multistage flash desalination process
Get PDFYesMultistage Flash (MSF) desalination process is still a dominant process, especially in the Gulf region, to produce high quality freshwater. Although there has been energy price surge in recent years, MSF process will continue to operate in that region for some foreseeable future. The key challenge is how to make such processes still profitable. Understanding the dynamics of any processes under uncertainty and disturbances is very important to make a process operationally feasible and profitable. The main aim of this work is to understand the dynamics of industrial scale MSF process using high fidelity and reliable process model. For this purpose, a detailed dynamic model for the MSF process incorporating key and new features is developed and validated against the actual data of a large-scale seawater desalination plant. The model is then used to study the behaviour of large scale MSF processes for disturbances in steam temperature, feed temperature and the recycle brine flow rate. The simulation results show that the last stage requires a longer time to settle compared to the preceding stages. In addition, steam temperature shows insignificant influence on the performance ratio compared to the inlet seawater temperature and recycle brine flow rate. Furthermore, it is found that the productivity of plant can increase in the winter compared to that in the summer. However, this benefit comes at the expense of increased steam consumption in the winter, resulting in a low performance ratio
Metal-Free Oxyacetoxylation of Arylynamines and Ynamides to Construct α-Acetoxyl Amides
Get PDFYesYnamides/arylynamines are challenging substrates for oxyacetoxylation, especially due to various reactive sites of N-heteroaryl ring. Herein we report a metal-free PhI(OAc)2-mediated oxyacetoxylation of arylynamines / ynamides to provide α-acetoxyl amides in good to excellent yields. The transformation completes in a short time to afford solely the product without functionalising N-heteroaryl moiety, in a highly regio- and chemo-selective manner through β-iodo keteneiminium intermediate