Fall prevention in the community: what older people say they need

Original article can be found at: http://www.bjcn.co.uk/ Copyright MA HealthcareUptake of and adherence to fall prevention interventions is often poor and we know little about how older people’s perceptions of and beliefs about fall prevention interventions affect uptake. This study aimed to explore older people’s perceptions of the facilitators and barriers to participation in fall prevention interventions. We undertook a qualitative study with older people who had taken part in, declined to participate or adhere to fall prevention interventions using semi-structured interviews (n=65), and 17 focus groups (n=122) with older people (including 32 South Asian and 30 Chinese older people) in primary and community care settings in the South of England. A number of factors acted as either barriers or facilitators to uptake of interventions. Older people also made recommendations for improving access to interventions. Community nurses are ideally placed to screen older people, identify those at risk of falling and refer them to appropriate interventions as well as providing health promotion and education.Peer reviewe

A Conservative Finite Difference Scheme for Poisson-Nernst-Planck Equations

A macroscopic model to describe the dynamics of ion transport in ion channels is the Poisson-Nernst-Planck(PNP) equations. In this paper, we develop a finite-difference method for solving PNP equations, which is second-order accurate in both space and time. We use the physical parameters specifically suited toward the modelling of ion channels. We present a simple iterative scheme to solve the system of nonlinear equations resulting from discretizing the equations implicitly in time, which is demonstrated to converge in a few iterations. We place emphasis on ensuring numerical methods to have the same physical properties that the PNP equations themselves also possess, namely conservation of total ions and correct rates of energy dissipation. We describe in detail an approach to derive a finite-difference method that preserves the total concentration of ions exactly in time. Further, we illustrate that, using realistic values of the physical parameters, the conservation property is critical in obtaining correct numerical solutions over long time scales

Descending aortic calcification increases renal dysfunction and in-hospital mortality in cardiac surgery patients with intraaortic balloon pump counterpulsation placed perioperatively : a case control study

Introduction: Acute kidney injury (AKI) after cardiac surgery increases length of hospital stay and in-hospital mortality. A significant number of patients undergoing cardiac surgical procedures require perioperative intra-aortic balloon pump (IABP) support. Use of an IABP has been linked to an increased incidence of perioperative renal dysfunction and death. This might be due to dislodgement of atherosclerotic material in the descending thoracic aorta (DTA). Therefore, we retrospectively studied the correlation between DTA atheroma, AKI and in-hospital mortality. Methods: A total of 454 patients were retrospectively matched to one of four groups: -IABP/-DTA atheroma, +IABP/-DTA atheroma, -IABP/+DTA atheroma, +IABP/+DTA atheroma. Patients were then matched according to presence/absence of DTA atheroma, presence/absence of IABP, performed surgical procedure, age, gender and left ventricular ejection fraction (LVEF). DTA atheroma was assessed through standard transesophageal echocardiography (TEE) imaging studies of the descending thoracic aorta. Results: Basic patient characteristics, except for age and gender, did not differ between groups. Perioperative AKI in patients with -DTA atheroma/+IABP was 5.1% versus 1.7% in patients with -DTA atheroma/-IABP. In patients with +DTA atheroma/+IABP the incidence of AKI was 12.6% versus 5.1% in patients with +DTA atheroma/-IABP. In-hospital mortality in patients with +DTA atheroma/-IABP was 3.4% versus 8.4% with +DTA atheroma/+IABP. In patients with +DTA atheroma/+IABP in hospital mortality was 20.2% versus 6.4% with +DTA atheroma/-IABP. Multivariate logistic regression identified DTA atheroma > 1 mm (P = *0.002, odds ratio (OR) = 4.13, confidence interval (CI) = 1.66 to 10.30), as well as IABP support (P = *0.015, OR = 3.04, CI = 1.24 to 7.45) as independent predictors of perioperative AKI and increased in-hospital mortality. DTA atheroma in conjunction with IABP significantly increased the risk of developing acute kidney injury (P = 0.0016) and in-hospital mortality (P = 0.0001) when compared to control subjects without IABP and without DTA atheroma. Conclusions: Perioperative IABP and DTA atheroma are independent predictors of perioperative AKI and in-hospital mortality. Whether adding an IABP in patients with severe DTA calcification increases their risk of developing AKI and mortality postoperatively cannot be clearly answered in this study. Nevertheless, when IABP and DTA are combined, patients are more likely to develop AKI and to die postoperatively in comparison to patients without IABP and DTA atheroma

Live Service Migration in Mobile Edge Clouds

Mobile edge clouds (MECs) bring the benefits of the cloud closer to the user, by installing small cloud infrastructures at the network edge. This enables a new breed of real-time applications, such as instantaneous object recognition and safety assistance in intelligent transportation systems, that require very low latency. One key issue that comes with proximity is how to ensure that users always receive good performance as they move across different locations. Migrating services between MECs is seen as the means to achieve this. This article presents a layered framework for migrating active service applications that are encapsulated either in virtual machines (VMs) or containers. This layering approach allows a substantial reduction in service downtime. The framework is easy to implement using readily available technologies, and one of its key advantages is that it supports containers, which is a promising emerging technology that offers tangible benefits over VMs. The migration performance of various real applications is evaluated by experiments under the presented framework. Insights drawn from the experimentation results are discussed

Exercise as Labour: Quantified Self and the Transformation of Exercise into Labour

The recent increase in the use of digital self-tracking devices has given rise to a range of relations to the self often discussed as quantified self (QS). In popular and academic discourse, this development has been discussed variously as a form of narcissistic self-involvement, an advanced expression of panoptical self-surveillance and a potential new dawn for e-health. This article proposes a previously un-theorised consequence of this large-scale observation and analysis of human behaviour; that exercise activity is in the process of being reconfigured as labour. QS will be briefly introduced, and reflected on, subsequently considering some of its key aspects in relation to how these have so far been interpreted and analysed in academic literature. Secondly, the analysis of scholars of “digital labour” and “immaterial labour” will be considered, which will be discussed in relation to what its analysis of the transformations of work in contemporary advanced capitalism can offer to an interpretation of the promotion and management of the self-tracking of exercise activities. Building on this analysis, it will be proposed that a thermodynamic model of the exploitation of potential energy underlies the interest that corporations have shown in self-tracking and that “gamification” and the promotion of an entrepreneurial selfhood is the ideological frame that informs the strategy through which labour value is extracted without payment. Finally, the potential theoretical and political consequences of these insights will be considered

Weight Loss and Illness Severity in Adolescents With Atypical Anorexia Nervosa.

BACKGROUND:Lower weight has historically been equated with more severe illness in anorexia nervosa (AN). Reliance on admission weight to guide clinical concern is challenged by the rise in patients with atypical anorexia nervosa (AAN) requiring hospitalization at normal weight. METHODS:We examined weight history and illness severity in 12- to 24-year-olds with AN (n = 66) and AAN (n = 50) in a randomized clinical trial, the Study of Refeeding to Optimize Inpatient Gains (www.clinicaltrials.gov; NCT02488109). Amount of weight loss was the difference between the highest historical percentage median BMI and admission; rate was the amount divided by duration (months). Unpaired t tests compared AAN and AN; multiple variable regressions examined associations between weight history variables and markers of illness severity at admission. Stepwise regression examined the explanatory value of weight and menstrual history on selected markers. RESULTS:Participants were 16.5 ± 2.6 years old, and 91% were of female sex. Groups did not differ by weight history or admission heart rate (HR). Eating Disorder Examination Questionnaire global scores were higher in AAN (mean 3.80 [SD 1.66] vs mean 3.00 [SD 1.66]; P = .02). Independent of admission weight, lower HR (β = -0.492 [confidence interval (CI) -0.883 to -0.100]; P = .01) was associated with faster loss; lower serum phosphorus was associated with a greater amount (β = -0.005 [CI -0.010 to 0.000]; P = .04) and longer duration (β = -0.011 [CI -0.017 to 0.005]; P = .001). Weight and menstrual history explained 28% of the variance in HR and 36% of the variance in serum phosphorus. CONCLUSIONS:Weight history was independently associated with markers of malnutrition in inpatients with restrictive eating disorders across a range of body weights and should be considered when assessing illness severity on hospital admission