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Transgender and gender diverse older people: health, aging and dementia
Get PDFBackground and Objectives262,000 people in the UK identify as transgender and gender diverse (TGD), and this population is believed to be growing. As the population is aging, an increase in older TGD people accessing health and social care can be anticipated. Despite a recent expansion in research exploring the TGD population, older TGD people are often excluded from the narrative. This review aims to address gaps in the literature by exploring the complex ways older TGD adults access health and social care and how this affects health outcomes with a specific focus on dementia.MethodsThe search was conducted using NUsearch, CINAHL, PsycINFO, PubMed, Google Scholar, and MEDLINE, in addition to cross-referencing and hand searches. Data were analyzed in a narrative, exploratory manner.FindingsOlder TGD adults face many barriers when accessing health and social care including experiences of discrimination, gatekeeping by healthcare professionals and limited access to services. These barriers impact on health outcomes in this population and their interactions with the health and social care system. There are high reported rates of poor physical and mental health, including HIV, mental illness and issues associated with gender-affirming treatment. Older TGD people are also reported to be at an increased risk of dementia, which is partly due to high incidences of dementia-associated risk factors. The epidemiology and experiences of older TGD people living with dementia are largely unknown due to limited research. However, the available literature suggests the current health and social care system is ill-equipped to manage their needs.ConclusionGreater research exploring the major health problems faced by this population is needed, to address health inequalities. Several approaches have been suggested to help improve services for older TGD people including, expert patient programmes, co-production, and a systems approach
Of Life and Breath: Towards Geographies of Breath and Breathing Bodies
Get PDFRecent scholarship has opened up the historical ‘black-boxing’ of the body in geographical research. Developments in critical health and feminist geographies, together with new materialism, have countered long-standing binaries perpetuated by the biomedical model of health. Contributing to health geographies, political ecology as a field has generated critical insights into the inter-related, complex and multi-layered nature of human-environment relations, as manifested in the production of (ill)health. In accordance with feminist political ecologists, this paper pushes for the incorporation of the visceral, fleshy, fluid body into geographical enquiries to propose an all-encompassing understanding of health and the body, that visibilises how intersecting structural vulnerabilities shape health outcomes. Building on feminist political ecology models, this article highlights how developments in new materialism - when read geographically - can re-imagine understandings on the body, health and the environment. Contributing to geographies of the body and geographies of breathing, this paper integrates new materialist thinking into a feminist political ecology framework, to attend to affective corpo-realities and the making of healthy environments and bodies, across time, place and scale. Through the example of breathing, this article highlights how intimate everyday metabolic processes are perpetually mediated by socio-political factors, which change the body's very constitution. Employing a biosocial approach to bodily processes, such as breathing, highlights how health is deeply entangled in everyday sociopolitical life. Crucially, this article argues for a reconceptualisation of the place-based relationship between air, breath and bodies to push for a preventative approach to the emergence of harmful, health-depleting assemblages in the context of breathing. In doing so, this theoretical intervention problematises variegated health outcomes to lay the groundwork for an emancipatory respiratory politics, where everyone is afforded the right to breathe
Recurrent ascending cholangitis secondary to food reflux following transduodenal resection of an ampullary adenoma
Get PDFAmpullary lesions, including adenomas and early-stage carcinomas, pose a diagnostic and therapeutic challenge due to their location and proximity to the pancreatic and bile ducts. Transduodenal ampullectomy offers a targeted approach for the resection of these lesions while preserving the integrity of the pancreaticobiliary system. Moreover, transduodenal ampullectomy is associated with favorable postoperative outcomes, including low rates of morbidity and mortality, as well as preservation of pancreatic and biliary function. However, potential complications such as ascending cholangitis pancreatic leakage, bleeding, and duodenal stenosis can occur which would impact the postoperative quality of life. Addressing these outcomes might require either endoscopic procedures or surgical interventions. We present an exceedingly uncommon case of recurrent ascending cholangitis resulting from reflux of food particles into the common bile duct that was treated successfully with a Roux-en-Y hepaticojejunostomy and gastroenterostomy
Investigating the fluid and electrolyte prescribing knowledge of Foundation Year doctors
Get PDFIntroductionChanges to the medical curriculum have been advocated to improve knowledge on fluid and electrolytes. We aimed to determine the contemporary level of knowledge of trainee doctors on different aspects of fluid and electrolyte prescribing.MethodsAn online survey was distributed to Foundation Year doctors working throughout the United Kingdom. The first part determined demographic information, where participants studied and currently work, and probed their perceptions of their knowledge on fluid and electrolytes. The second part tested knowledge on a wide variety of aspects of fluid and electrolyte management using 20 multiple-choice questions.ResultsIn total, 190 responses were received. Trainee doctors remain responsible for much of the fluid and electrolyte management of patients, and often practise independently. Overall, the average ‘score’ of each respondent was suboptimal (52%), with no significant difference found between doctors in the first or second year of postgraduate medical practice. Many participants were unable to correctly identify the components of common intravenous fluid products. Understanding of daily electrolyte requirements was also demonstrated poorly, although most showed a good understanding of the daily requirements of water and glucose. The amount of time in medical school allocated to the topic remains low, as do doctors' confidences in their abilities to prescribe fluid and electrolytes.ConclusionsKnowledge surrounding fluid and electrolyte prescribing remains suboptimal, and Foundation Year doctors are frequently undertaking this responsibility independently. These findings reflect previous research performed over the past 20 years, and little improvement appears to have been made
Green Credit Policy and Environmental Outcomes in China: The Critical Role of Local Banks in Pollution Reduction and Innovation
Get PDFThis research assesses the role of local banks in the environmental consequences of the green credit policy (GCP) implementation in China. Utilising a sample of 297 cities from 2010 to 2017 and employing a difference-in-difference model, the study examines whether cities with local banks experience a significant reduction in environmental pollution post-GCP implementation. The 2012 introduction of GCP serves as an exogenous shock, revealing that cities with local banks show a substantial decrease in pollution levels, thereby supporting Porter's hypothesis and relationship banking theory. Mechanism analysis indicates that local banks contribute to pollution mitigation by promoting innovation. Besides, the role of local banks in pollution reduction is more pronounced in cities with higher levels of foreign direct investment and economic development. Overall, our findings underscore the importance of supporting local banks in their green credit initiatives to achieve significant environmental benefits
Digital-twin-assisted multi-stage machining of thin-wall structures using interchangeable robotic and human-assisted automation
Get PDFInterconnected intelligent systems in multi-stage smart machining environments are an advancing area of research, demonstrating many real-life opportunities that can benefit from the development and integration of cyber-physical systems into machining habitats, while different automation levels in industrial manufacturing sites call for flexibility of core strategies towards smart machining ecosystems. This article introduces a versatile and smart multi-stage machining environment for the controlled clamping and machining of low-rigidity structures in an interconnected cyber-physical factory. This is exemplified by a deformation-prone thin-wall workpiece, which undergoes controlled clamping, enabled by interchangeable robotic automation and automation via human-cyber-physical systems, as well as digital-twin-assisted corrective machining enabled by the swift estimation of workpiece deformations and multi-stage communication between machining habitats. The underlying digital twin presents a fast, lightweight simulation approach, based on a mass-spring-lattice model, allowing information flow from and to systems, which is utilized by the CNC machine as well as the interchangeable robot- and human-in-the-loop clamping enablers. By employing this controlled clamping approach workpiece deformations are aimed to be minimized. At the same time, a desired total clamping force is achieved in order to perform subsequent digital-twin-assisted machining corrections to reduce deformation-caused flatness errors. Ultimately, this article presents an intelligent multi-stage machining scenario where digital-twin enabled information moves along with thin-wall structures and branches out for knowledge-based control and corrections to robots, humans and CNC machines respectively, showcasing a real-life example for versatile, information-driven smart machining ecosystems
pTRACK-generated normalized average T2 signal intensity and fistula volume are accurate and sensitive measures of perianal Crohn’s disease activity
No full textObjectives Fistula T2 signal intensity and volume are predictive of treatment response in IBD. We aimed to evaluate pTRACK-generated MRI metrics against MAGNIFI-CD, assessing predictive value for clinical outcomes. Methods MRI and clinical assessment cases of 46 patients with pCD were included. T2 signal intensity was normalized using ROI in adjacent pelvic muscles. Clinical outcomes were scored using physician global assessment. Correlations, unpaired 2-tailed t-tests, and receiver operating characteristics curve analyses performance metrics were used to compare MRI metrics and predict PGA categories. Results Normalized average T2 signal intensity demonstrated AUC 0.784 (95% CI: 0.648-0.893). Optimal threshold for classification was 1.527, with accuracy of 80.0%, with high sensitivity (0.857) and moderate specificity (0.632). MAGNIFI-CD scores (ICC=0.87, 95% CI: 0.45-0.98, P=.0014), fistula volume (ICC=0.81, 95% CI: 0.21-0.97, P=.0103) showed good-excellent reliability. Significant differences were observed when dichotomized into remission and active groups: T2 signal intensity (1.55ms ± 0.88 vs. 2.87ms ± 1.42, P<.001), fistula volume (2.0±3.3mL vs. 4.3±8.7mL, P=.04) and MAGNIFI-CD (5.86±4.70 vs. 12.41±5.80, P<.001). Conclusions pTRACK’s normalized T2 signal demonstrated comparable accuracy to MAGNIFI-CD, with higher sensitivity for predicting pCD activity. These findings underscore pTRACK's potential utility, warranting prospective validation in cohorts with more severe disease. Advances in Knowledge pTRACK enables radiologists to measure fistula volume, normalized average T2 signal intensity, and generate 3D digital models, and has shown comparable accuracy to MAGNIFI-CD
A Soft Switched Three Level Quasi Z-Source Converter with Coupled Inductor Based High Converter Ratio and Continuous Input Current for Renewable Energy Application
Get PDFIn this paper, a fully soft switched high step up three level converter based on a Quasi-impedance source is introduced for use in photovoltaic applications. In the proposed converter, since an active switch is used instead of the diode in the impedance network, conduction loss associated with the diode is reduced, and Zero-voltageswitching characteristics are provided in a wide range of output power for power switches, resulting in the improvement of efficiency. The proposed converter takes advantage of three level structure and it experiences much lower voltage stress on semiconductor elements compared to existing high step-up structures. This allows the use of MOSFETs with lower on the resistance, leading to reduced conduction losses and cost. Furthermore, the boost inductor in the input section not only maintains continuous input current, avoiding the need for bulky input capacitors, but also significantly optimizes power density and reduces cost. Other advantages of the proposed converter include high voltage gain with low duty cycle and the ability to turn off all diodes under ZCS condition. Experimental results from a 200-W laboratory prototype are provided to validate the proposed converter's performance
Programmes for people who are homeless and have severe mental illness in low-income and middle-income countries: a systematic review
Get PDFHomelessness and severe mental illness are interrelated issues, the co-occurrence of which leads to poor outcomes for affected individuals. Evidence for effective interventions in high-income countries is accruing, but little is known about how to intervene in the diverse sociocultural contexts of low-income and middle-income countries (LMICs). The aim of this systematic review was to synthesise peer-reviewed and grey literature on programmes for people experiencing homelessness and severe mental illness in LMICs. We synthesised effects, programme components, and implementation strategies. We identified 80 sources describing 45 programmes across ten LMICs. Programme components spanned seven domains: service models, basic needs, health care, outreach, empowerment, community level, and macro level. Most programmes were multicomponent and included diverse delivery agents. Evaluation studies (n=21), although few in number and quality, reported clinical improvements; family reintegration ranged from 6% to 69%. Frequently reported implementation strategies included network weaving, educational meetings, and involvement of patients and family members. We identified programmes that show promise and can serve as starting points for local adaptation. This systematic review identifies common domains of programmatic interventions that are important to include in combination for future programme design, while considering local contexts and population-specific needs. Future research should prioritise rigorous evaluations, with particular emphasis on programme effects and cost benefits
Validation of the use of ToF-SIMS for analysis of glycosaminoglycans
Get PDFGlycosaminoglycans (GAGs) have a range of biological roles and are of particular interest for their pharmaceutical efficacy and their potential as biomarkers or drug targets. Heparin, used globally as an anticoagulant and an antithrombotic, is predominantly derived from porcine sources but bovine and ovine sources are increasingly being considered to reduce the substantial risk of reliance on a single animal species. However, high sensitivity chemical discrimination of heparins from different species is a significant analytical challenge. In this study ToF-SIMS analysis of GAGs is investigated as a methodology to achieve specific chemical discrimination between GAGs of different types and heparins from different animal sources. The ToF-SIMS data acquisition is relatively fast (≈1 min per sample) and requires minimal sample amounts (75 pg of sample analysed). Multivariate analysis (MVA) models enabled high selectivity between GAG type and animal source of heparin, and for the high sensitivity detection of GAG-contaminants within porcine derived heparin. Contaminants are detected down to 0.001 wt%, with the exception of ovine derived heparin where differences could be detected to 0.01 wt%. Assessments of specificity, precision, robustness and quantification limits are conducted to validate the approach for heparin analysis
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