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Effect of spironolactone on physical performance in older people with self-reported physical disability
No full textBackgroundInterventions that improve muscle function may slow decline in physical function and disability in later life. Recent evidence suggests that inhibition of the renin-angiotensin-aldosterone system may maintain muscle function. We evaluated the effect of aldosterone blockade on physical performance in functionally impaired older people without heart failure.MethodsIn this parallel-group, double-blind, randomized, placebo-controlled trial, community-dwelling participants aged =65 years with self-reported problems with activities of daily living were randomized to receive 25 mg spironolactone or identical placebo daily for 20 weeks. The primary outcome was change in 6-minute walking distance over 20 weeks. Secondary outcomes were changes in Timed Up and Go test, Incremental Shuttle Walk Test, Functional Limitation Profile, EuroQol EQ-5D, and Hospital Anxiety and Depression Scale over 20 weeks.ResultsParticipants’ mean (standard deviation) age was 75 (6) years. Of the 93% of participants (112/120) who completed the study, 106 remained on medication at 20 weeks. There was no significant difference in change in 6-minute walking distance at 20 weeks between the spironolactone and placebo groups (mean change, -3.2 m; 95% confidence interval, -28.9 to 22.5; P = .81). Quality of life improved significantly at 20 weeks, with an increase in EuroQol EQ-5D score of 0.10 (95% confidence interval, 0.03-0.18; P < .01) in the spironolactone group relative to the placebo group. There were no significant differences in between-group change for other secondary outcomes.ConclusionsSpironolactone was well tolerated but did not improve physical function in older people without heart failure. Quality of life improved significantly, and the possible mechanisms for this require further study
Approaching the physical-biological interface in rivers::a review of methods for ecological evaluation of flow regimes
No full textNew European legislation known as the Water Framework Directive (WFD) challenges catchment hydrologists and freshwater biologists to quantify the risk of damage to the organic communities of rivers that arises from anthropogenic distortion of the natural flow regime. Here, we take the first step towards this goal by collecting together relevant information from the two disciplines. An extensive biological literature is examined for insights into the ways in which the species and communities associated with rivers might change when the flow regime is altered. From the hydrological literature, the indicators of flow regime and flow regime change that are pertinent to ecology are described, and consideration is given to means of deriving flow regime data for ungauged river reaches. Attempts to combine hydrology and ecology in classifying rivers and in setting flow objectives to favour biota are then reviewed, together with integrated approaches to river management that aim to promote ecological quality. A significant scale disparity is noted between the disciplines, hydrology being studied at catchment, subcatchment and reach scales, and biology generally at local level. Nonetheless, both yield methods with potential applications in aspects of WFD implementation. The approach with most appeal for general risk assessment is based on the concept of hydrological alteration. This technique employs flow regime variables selected for their importance to aquatic and riparian ecology, and quantifies deviations from the natural values of these variables at reach scale. For WFD purposes, calibration of the scale of hydrological alteration in terms of risk to ecological status is desirable. In this, priority should be given to identification of the level of hydrological alteration that corresponds to the division between good and moderate ecological status
Argument Revision as a means of supporting dishonesty
No full textIn this paper, we demonstrate how our previous work on Argument Revision can be used to assist a participant in a dialogue to be dishonest. We first provide answers to the questions of why a participant would choose to lie, and what constitutes a lie in terms of structured argumentation. We then go on to show how Argument Revision can be used not only in selecting a "minimal" lie, but also in maintaining that lie in order to avoid detection
Dental neglect as a marker of broader neglect:a qualitative investigation of public health Nurses' assessments of oral health in preschool children
No full textBackgroundChild neglect is a pernicious child protection issue with adverse consequences that extend to adulthood. Simultaneously, though it remains prevalent, childhood dental caries is a preventable disease. Public health nurses play a pivotal role in assessing oral health in children as part of general health surveillance. However, little is known about how they assess dental neglect or what their thresholds are for initiating targeted support or instigating child protection measures. Understanding these factors is important to allow improvements to be made in care pathways.MethodsWe investigated public health nurses' assessment of oral health in preschool children in relation to dental neglect and any associations they make with child neglect more broadly. A qualitative study was conducted in Scotland during 2011/12. Sixteen public health nurses were recruited purposively from one health region. Individual, semi-structured interviews were undertaken and data were analyzed inductively using a framework approach. Categories were subsequently mapped to the research questions.ResultsPublic health nurses assess oral health through proxy measures, opportunistic observation and through discussion with parents. Dental neglect is rarely an isolated issue that leads on its own to child protection referral. It tends to be other presenting issues that initiate a response. Threshold levels for targeted support were based on two broad indicators: social issues and concerns about child (and parental) dental health. Thresholds for child protection intervention were untreated dental caries or significant dental pain. Barriers to intervention are that dental neglect may be 'unseen' and 'unspoken'. The study revealed a communication gap in the care pathway for children where a significant dental problem is identified.ConclusionsPublic health nurses take their child protection role seriously, but rarely make a link between dental caries and child neglect. Clear guidance on oral health assessment is required for public health nurses. Establishing formal communication pathways between child dental care providers and public health nurses may help close gaps in care pathways. However, further research is required into how these communication mechanisms can be improved
Mapping sub-pixel proportional land cover with AVHRR imagery
No full textA problem with NOAA AVHRR imagery is that the intrinsic scale of spatial variation in land cover in the U.K. is usually finer than the scale of sampling imposed by the image pixels. The result is that most NOAA AVHRR pixels contain a mixture of land cover types (sub-pixel mixing). Three techniques for mapping the sub-pixel proportions of land cover classes in the New Forest, U.K. were compared: (i) artificial neural networks (ANN); (ii) mixture modelling; and (iii) fuzzy c-means classification. NOAA AVHRR imagery and SPOT HRV imagery, both for 28 June 1994, were obtained. The SPOT HRV images were classified using the maximum likelihood method, and used to derive the 'known' sub-pixel proportions of each land cover class for each NOAA AVHRR pixel. These data were then used to evaluate the predictions made (using the three techniques and the NOAA AVHRR imagery) in terms of the amount of information provided, the accuracy with which that information is provided, and the ease of implementation. The ANN was the most accurate technique, but its successful implementation depended on accurate co-registration and the availability of a training data set. Supervised fuzzy c-means classification was slightly more accurate than mixture modelling.</p
The public health specialist and access to public health advice
No full textPublic health specialists can be described as leaders of the ‘upstream health workforce’, concerned with preventing unnecessary and ‘revolving door’ contact with health services. Achieving this requires working to promote good health, improve health services and protect populations from infectious disease and environmental risks. Public health work is based upon the recognition that populations are complex constructions of groups of individuals, who may or may not seek help for health problems or be able effectively to take action to improve their own health. This article will define key areas of public health practice giving specific examples of the role of the public health specialist in the UK, as well as how and why primary care professionals might access specialist advice. The examples demonstrate the great potential for improving population health through the complementary efforts of primary care and public health professionals
Coming in from the cold:the Transitional Executive Council and South Africa’s reintegration into the international community
No full textSouth Africa’s ‘miraculous’ transition from apartheid to democracy,1990–1994, has been widely investigated in the current literature, but the activities of the Transitional Executive Council, and, more importantly, those of its composite sub-councils have been neglected. This study analyses the significant influence the Sub Council on Foreign Affairs (SCFA) had on the shape of South Africa’s foreign policy after April 1994. The influence the Department of Foreign Affairs had over the organisation and activities of the SCFA is also explored. In shapingthe final recommendations of the Sub Council, so that they closely represented those of the Department, the SCFA’s proposals also reflected the norms and values of the wider international community. It is argued that entrenched domestic and international interests ‘captured’ the new South Africa’s foreign policy, seriously impinging on the African National Congress’s room for manoeuvre internationally and ultimately acting as a significant factor in accounting for the country’s perceived inconsistent foreign policy after 1994
Contemplating Moments
No full textMoment, is an art installation that asks you to pause for a moment to contemplate This article reflects on the process of the collaboration as well as Lithium! the conceptual and practical issues of the project. The work was realized within the framework of the European Mobile Lab for Interactive Artists (e-MobiLArt) and funded through the CULTURE 2007 Programme of the European Union</p
Application of gel-casting to the fabrication of 1-3 piezoelectric ceramic-polymer composites for high-frequency ultrasound devices
No full textA modified gel-casting technique was used to fabricate a 1-3 piezoelectric ceramic/polymer composite substrate formed by irregular-shaped pillar arrays of small dimensions and kerfs. This technique involves the polymerization of aqueous piezoelectric (PZT) suspensions with added water-soluble epoxy resin and polyamine-based hardener that lead to high strength, high density and resilient ceramic bodies. Soft micromoulding was used to shape the ceramic segments, and micropillars with lateral features down to 4 m and height-to-width aspect ratios of ~10 were achieved. The composite exhibited a clear thickness resonance mode at approximately 70 MHz and a k eff ~ 0.51, demonstrating that the ceramic micropillars possess good electrical properties. Furthermore, gel-casting allows the fabrication of ceramic structures with non-conventional shapes; hence, device design is not limited by the standard fabrication methods. This is of particular benefit for high-frequency transducers where the critical design dimensions are reduced
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