303 research outputs found
Chronic kidney disease and hip-fracture mortality in older people in the UK
No full textBACKGROUND: Dialysis patients have increased hip fracture rates when compared to the general population of the same age and sex. There have been few studies of the association of earlier stages of chronic kidney disease (CKD) with hip fractures amongst older people in the general population. The aim of this study was to examine whether CKD at older ages is associated with hip-fracture-related mortality. METHODS: In a trial of health and social assessment of people aged 75 and over in the UK with baseline assessment between 1995 and 1998, there were 13 177 (87%) participants in 53 general practices who had a serum creatinine measured at baseline. Estimated glomerular filtration rate (eGFR) was derived from the modification of diet in renal disease formula (MDRD). Mortality follow-up using linkage to national mortality data was until the end of November 2005. We used propensity scores to adjust for potential confounders in Cox regression models. RESULTS: There were 84 hip-fracture-related deaths over a median follow-up of 7.25 years (IQR 3.79-8.77). Compared to eGFR 60 ml/min/1.73 m(2) and above, the age- and sex-adjusted hazard ratio (HR) for hip-fracture-related death was 1.06 (95% confidence interval: 0.71, 1.58) for eGFR 45-59 and 1.98 (1.12, 3.50) for eGFR < 45. In adjusted models, the HR for eGFR < 45 ml/min/1.73 m(2) compared to above was 1.81 (1.11, 2.96). CONCLUSIONS: Amongst older people, an eGFR of <45 ml/ min/1.73 m(2) is associated with an almost 2-fold increase in hip-fracture-related mortality<br/
Detecting chronic kidney disease in older people; what are the implications?
No full textBACKGROUND: national policy is focused on early identification, referral and management of chronic kidney disease (CKD) to prevent both progression to endstage renal failure and cardiovascular disease. However, the significance of identifying CKD in older people is unclear. OBJECTIVE: to determine the frequency of CKD in older people using estimated glomerular filtration rate (eGFR), and its associations with morbidity and functional measures. DESIGN: observational cross-sectional analysis of baseline data from a large cluster randomised trial of health and social assessment of older people in the community. SETTING: included 53 general practices in Great Britain. SUBJECTS: subjects were people aged 75 and over, living in the community participating in the trial arm where systematic blood testing was undertaken. METHODS: the response rate for participation at baseline assessment of those eligible was 73% (15,536/20,934), of whom 13,109 (86%) participants had a serum creatinine measured, and an eGFR derivable using the Modification of Diet in Renal Disease formula (MDRD) in ml/min/1.73 m(2). Key outcomes were the prevalence of CKD stages and their associations with morbidity and functional status. RESULTS: prevalence of CKD was 56.1% (95% CI 55.3-57.0) for eGFR 45 need to be determine
CKD and mortality risk in older people: a community-based population study in the United Kingdom
No full textBackground: the prevalence of chronic kidney disease (CKD) increases with age; however, theprognostic significance in older people is uncertain. This study aims to determine the association of CKDwith all-cause and cardiovascular mortality in community-dwelling older people 75 years and older.Study Design: Cohort study of people 75 years and older recruited in 1994 to 1999 to 1 arm of a trialof multidimensional health assessment with mortality follow-up.Setting & Participants: 53 general practices in Great Britain. 15,336 (73%) of those eligibleparticipated. 13,177 (86%) had serum creatinine measured at baseline.Main Factor: estimated glomerular filtration rate (eGFR).Outcomes: All-cause and cardiovascular mortality.Measurements: eGFR derived from serum creatinine level using the 4-variable Modification of Diet inRenal Disease (MDRD) Study equation in milliliters per minute per 1.73 m2; dipstick proteinuria.Mortality by linkage to national death registration and death certification.Results: after a median follow-up of 7.3 years (interquartile range, 5.0), 7,633 (58%) had died, 42% ofcardiovascular causes. In the first 2 years of follow-up, adjusted hazard ratios for all-cause mortality ineGFR bands of 45 to 59, 30 to 44, and less than 30 compared with eGFR greater than 60 mL/min/1.73m2 were 1.13 (95% confidence interval, 0.93 to 1.37), 1.69 (95% confidence interval, 1.26 to 2.28), and3.87 (95% confidence interval, 2.78 to 5.38) in men and 1.14 (95% confidence interval, 0.93 to 1.40),1.33 (95% confidence interval, 1.06 to 1.68), and 2.44 (95% confidence interval, 1.68 to 3.56) in women,respectively. Hazard ratios were greater for cardiovascular mortality and lower after 2 years. Dipstickproteinuria was independently associated with all-cause, but not cardiovascular, mortality risk in bothsexes.Limitations: single serum creatinine measurement, no calibration of serum creatinine, MDRD Studyequation not validated in older people.Conclusion: As kidney function decreases, there is a graded and independent increase in all-causeand cardiovascular mortality risk in older people 75 years and older, especially in men and those witheGFR less than 45 mL/min/1.73 m2. Dipstick proteinuria did not add to cardiovascular mortality risk inthis elderly population. In older people, identification and management of CKD should prioritize thesmaller numbers with more severe CKD
Bargaining power
No full textBargaining Power examines the balance of power between management and unions, showing why some managements and some trade unions are more powerful than others. Bargaining power has long been recognized as central to industrial relations, but no previous work has taken the issue as its central focus.Using both sociological and economic evidence, the author shows how managements and unions approach negotiations and how they use power to achieve their bargaining objectives. In turn he analyses different perspectives on power, negotiations, the industrial relations context, and human resources management.The book concludes with an examination of the changing position of trade unions in Britain in the 1980s, arguing that union bargaining power remains more significant than suggested by the decline in union membership.Contents Introduction: Definitions, measurement, and model
1. The development of bargaining theory , with Philip Beaumont
2. Environmental influences on bargaining power , with Andrew Thomson
3. Values, beliefs, objectives, and bargaining power
4. Bargaining power inaction
5. The influence of bargaining power on the outcomes of collective bargaining
6. Bargaining power in changing contexts: hotels and catering, motor vehicles, and local government
7. Trade Union power at the beginning of the 1990s: secular decline or terminal collapse
Polyphony and the anxiety of influence in the fiction of Henry James
No full textJames's fiction, especially in the Middle Phase, centres
on the figure of the artist and is characterized by, the two
interrelated aspects which previous criticism has largely
overlooked: the Bakhtinian 'polyphonic' -creation of
'author-thinkers'; and the conflict between ephebes and
precursors, for which Harold-Bloom's concept of 'the-anxiety of
influence' is the most illuminating model. Polyphony is the
narrative mode, and influence is the intra-artistic, theme.
These, as the Introduction to the thesis makes clear, are
rehearsed in James's inaugural novel, Roderick Hudson. Rowland
Mallet is an author-thinker, and his failure is caused by
authorial limitations. His monologism -is impaired by his
mistaking empathy for the authorial sympathy. Likewise,
Hudson's failure does not arise from a mercurial temperament,
but from a polyphonic shortcoming: not possessing the power of
fiction to contain the fiction of power in, his mentor. And the
relationships among the three artists - Gloriani, Hudson and
Singleton - perfectly exemplify the Bloomian-theme. It is these
two concepts, polyphony and influence, which are the major
preoccupation in the Middle Phase; as, the works chosen
demonstrate. These are a novella, a novel, and a number of
short stories all of which have been unjustifiably neglected.
Chapter One, on The Aspern Papers, argues that Tina Bordereau,
far from being, the artless victim seen by many critics,
actually challenges and defeats the narrator by the very form
of her narrative. Her 'realist' discourse undermines his
language of 'romance', and shows up its internal unstability.
Chapter Two is an extensive study of the critical reception of
The Tragic Muse. The most common areas of critical attention
have been its contemporary topicality, its relation to previous
novels on similar themes, and the possible genealogy of Gabriel
Nash. Those have all missed the core of the work. - Chapter Three
demonstrates how polyphony and the anxiety of influence make
the novel what it really is. Influence arises from the
juxtaposition of, and the wrestling between, artistic ephebes
and their precursors (Nick and Nash,, Miriam and Madame Carre).
The dialogic quality defined by Bakhtin is crucial to the
proper, and even-handed, characterization of all, the conflicts
in the novel. And since most of James's tales in the eighties
and nineties -are about 'masters - and acolytes, the anxiety of
influence remains central. Chapter Four is a study of 'The
Author of Beltraffiol' and 'The Lesson of the Master'. Again the
characters' manipulations are a crucial focus in a way that
G6rard Genette's terminology helps to illuminate. The fact that
the ephebe is the author-thinker emphasizes the inextricability
of the Bakhtinian and the Bloomian in James. Just as
polyphony offers a different focus for explicating the poetics
of James's fiction; so the ephebal conflict provides the basis
for a fresh perception of James's own artistic struggle
Rescate y conservación del Acervo Histórico del Palacio de Minería: Informe de las labores de conservación preventiva e intervenciones menores en material Bibliohemerográfico y actividades en apoyo al Acervo Histórico : octubre 2011 - febrero 2012
No full textEl presente informe tiene como finalidad dar constancia de los trabajos realizados en el Acervo Histórico del Palacio de Minería, por los restauradores Roderick Palacios, Isabel Ritter y Eleonora Cruz, pasantes de la Licenciatura en Restauración de Bienes Culturales como prestación de su servicio social.</p
Defining the construction characteristics of indigenous boats of the Philippines: the impact of technical change pre and post colonisation
No full textThe thesis reviews the key construction characteristics of traditional vessels used by the inhabitants of the Philippines at the time of European colonisation in the sixteenth century. These included the use of carved rather than sawn wood, the use of outriggers, and the utilisation of dowel technology and the lashed lug technique to maintain hull stability. The social context of the local maritime culture is analysed, as is the relationship between the Philippine communities and the sea. Prior to colonisation, the Philippines were involved in a trading network with other parts of Southeast Asia and particularly China. This thesis will review evidence of the interplay between indigenous technology and external influences from other parts of Asia. After colonisation the Spanish began the construction of European-style vessels using Philippine resources. The impact of this experience on traditional boat-building is traced. The methodology used is an analysis of the relevant maritime archaeological sites and museum collections in the Philippines. This is complemented by an analysis of historical accounts by visitors, priests and colonial officials. The results incorporate the ethnographic studies of traditional boats still in use, carried out by the author. A tour of Southeast Asian sites was undertaken to put the Philippine results in context. The integration of the traditional style of boat building and imported technology to produce the modern Philippine banca is reviewed.<br/
A spectroscopic investigation of gallium lanthanum sulphide based glasses for optical devices
No full textThe optical communications network requires an efficient and cost effective 1.3 #mu#m optical fibre-amplifier. The Praseodynium ion (Pr"3"+) 1.3 #mu#m transition is the best candidate but requires a glass host with low phonon energy to produce a high radiative efficiency. Gallium Lanthanum Sulphide (GLS) based glasses are investigated as potential low phonon energy hosts. The work reported aims to link the spectroscopic results to the observed physical and optical properties and to the composition and atomic structure of the glasses. The Pr"3"+ doped GLS glass shows a high radiative quantum efficiency (RQE) for the 1.3 #mu#m transition and the lifetime of the transition is also long indicating a potentially useful glass dopant system. The Pr"3"+ enters the glass with a large coordination number and is sulphur coordinated. The Pr"3"+ doped GLS glass spectroscopic, optical and physical properties are found to be extremely susceptible to oxide impurities and added La_2O_3. In the Gallium Lanthanum Oxy-Sulphide (GLSO) glass the Pr"3"+ spectroscopy becomes excitation wavelength dependent. The temperature range of glass formation is increased as more oxide is added whilst the RQE and lifetime of the 1.3 #mu#m transition are strongly reduced. This is explained through new oxide coordination for the Pr"3"+, which experiences a higher energy phonon and a different nephelauxetic shift of the Stark levels. The increased temperature range for glass formation of the GLSO glass is beneficial since the range of GLS glass is small. By adding metal halides to the GLS glass it was hoped that the improved glass forming properties of the GLSO glass could be kept along with the high RQE and lifetime of the 1.3 #mu#m transition. The metal halide CsCI provided the largest increase in glass forming temperature range. The RQE was slightly reduced from the GLS value but much larger than the GLSO value. The lifetime was the longest measured. The dependence of the physical and optical properties on amount of metal halide was explained by changes in the bonding of the glass formers whilst the spectroscopic properties were most strongly influenced by bulk glass effects indicating a similar coordination for the Pr"3"+ in the GLS and CsCI GLS glasses. The doped GLS glass was not found to obey the simple multiphonon non-radiative decay formula with each rare-earth transition needing to be assessed individually. (author)SIGLEAvailable from British Library Document Supply Centre-DSC:DXN027875 / BLDSC - British Library Document Supply CentreGBUnited Kingdo
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