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1.
Proc Natl Acad Sci U S A ; 120(47): e2206235120, 2023 Nov 21.
Article in English | MEDLINE | ID: mdl-37956276

ABSTRACT

The paper explores three periods in the UK electricity consumption-production system since World War II. The first two involved the development of an increasingly centralized, integrated system that provided electricity to meet growing post-war demand. It saw two major changes in governance, first to nationalization, then to privatization and liberalization. The third period started at the turn of the Century, driven by increasing evidence of the impact of fossil fuels on the Earth's climate. The paper focuses on the drivers of change, within the UK and externally, and how they affected governance, technology deployment, and industry structure. It draws on the multi-level perspective and the concepts of governance and technological branching points to inform the analysis of each period. It shows that there is a considerable distance to travel toward a truly sustainable electricity system.

2.
Sensors (Basel) ; 21(23)2021 Nov 28.
Article in English | MEDLINE | ID: mdl-34883950

ABSTRACT

Smartphone accelerometers and low-cost Global Navigation Satellite System (GNSS) equipment have faced rapid and important advancement, opening a new door to deformation monitoring applications such as landslide, plate tectonics and structural health monitoring (SHM). The precision potential and operational feasibility of the equipment play an important role in the decision making of campaigning for affordable solutions. This paper focuses on the evaluation of the empirical precision, including (auto)time correlation, of a common smartphone accelerometer (Bosch BMI160) and a low-cost dual frequency GNSS reference-rover pair (u-blox ZED-F9P) set to operate at high rates (50 and 5 Hz, respectively). Additionally, a high-rate (5 Hz) GPS-only baseline-based multipath (MP) correction is proposed for effectively removing a large part of this error and allowing to correctly determine the instrumental noise of the GNSS sensor. Furthermore, the benefit of smartphone-based validation for the tracking of dynamic displacements is addressed. The estimated East-North-Up (ENU) precision values (σ^) of ±7.7, 8.1 and 9.6 mms2 are comparable with the declared precision potential (σ) of the smartphone accelerometer of ±8.8mms2. Furthermore, the acceleration noise shows only mild traces of (auto)correlation. The MP-corrected 3D (ENU) empirical precision values of ±2.6, 3.6 and 6.7 mm were found to be better by 30-40% than the straight-out-of box precision of the GNSS sensor, attesting the usefulness of the MP correction. The GNSS sensors output position information with time correlation of typically tens of seconds. The results indicate exceptional precision potential of these low-power-consuming, small-scale, affordable sensors set to operate at a high-rate over small regions. The smartphone-based dynamic displacement validation shows that GNSS data of a low-cost sensor at a 5 Hz sampling rate can be successfully used for tracking dynamic processes.


Subject(s)
Acceleration , Smartphone , Accelerometry , Data Collection
3.
Trop Anim Health Prod ; 53(6): 537, 2021 Nov 10.
Article in English | MEDLINE | ID: mdl-34757524

ABSTRACT

Surra is a parasitic disease caused by Trypanosoma evansi and transmitted non-cyclically by biting flies. The disease significantly affects the health, productivity, and market value of camels thereby constituting a major constraint to food safety, security, and economy. This is the first study on the prevalence of surra in northwestern Nigeria, using a range of diagnostic tests along the parasitological-serological-molecular continuum hence, emphasizing it as a major enzootic risk for camels in Nigeria. In this cross-sectional study, 600 blood samples were collected from camels at major abattoirs in northwestern Nigeria and evaluated for the prevalence of T. evansi using parasitological (Giemsa staining), serological (CATT/T. evansi), and molecular (VSG-PCR and sequencing) methods. The overall prevalence of surra recorded in this study was 5.3%, 11.5%, and 22.5% using Giemsa-stained blood smears, CATT/T. evansi, and VSG-PCR respectively. However, higher prevalence rates at 6.0%, 13.7%, and 26.7% by Giemsa-stained blood smears, CATT/T. evansi, and VSG-PCR were recorded in Katsina State compared with results from Kano State. A significantly (p < 0.05) higher prevalence by VSG-PCR was observed when compared with both parasitological and serological methods used. Although age and body condition scores were associated (p < 0.05) with surra prevalence in sampled camels, no seasonal association (p > 0.05) was recorded. Sequencing of the VSG region of Trypanosoma spp. Further confirmed the presence of T. evansi as the aetiological agent of surra from the sampled camels. Findings from this study call for the implementation of adequate control measures aimed at reducing the impact of T. evansi infections on camel production in Nigeria.


Subject(s)
Trypanosoma , Trypanosomiasis , Animals , Camelus , Cross-Sectional Studies , Nigeria/epidemiology , Trypanosoma/genetics , Trypanosomiasis/epidemiology , Trypanosomiasis/veterinary
4.
BMC Psychiatry ; 20(1): 57, 2020 02 10.
Article in English | MEDLINE | ID: mdl-32039715

ABSTRACT

BACKGROUND: The demand for support for persons with mild intellectual disability or borderline intellectual functioning is growing rapidly. These persons often encounter individual and familial limitations that influence their human functioning, and often have difficulty coping with the demands of modern society. Although in the areas of policy, research and practice, people with mild intellectual disability or borderline intellectual functioning are generally approached as one group, important differences between them have been reported. Current support seems to be both suboptimal and insufficiently differentiated. METHODS: In this Delphi study we aimed to explore the need for appropriate and differentiated support for individuals with mild intellectual disability or borderline intellectual functioning. The study was based on five unique profiles of persons with mild intellectual disability or borderline intellectual functioning that are associated with individual and environmental variables. The opinions of expert primary caregivers, professional caregivers and scientists were analysed for potentially appropriate types of support for each of the five profiles. RESULTS: A total of 174 statements, divided over the five profiles, were presented to the participants. For 74 statements, consensus was reached between the expert groups. For each profile, these consensual statements represented specific items (e.g. concrete personal goals) and non-specific items (e.g. the attitude towards persons with mild intellectual disability or borderline intellectual functioning, and the coordination of health care) related to the support needs. CONCLUSION: This Delphi-based study generated consensual opinions contributing to a more differentiated system of support for individuals with mild intellectual disability or borderline intellectual functioning. Although these findings need additional investigation, they address actions that might enhance the support programmes for these individuals into more personalized support.


Subject(s)
Caregivers/psychology , Consensus , Delphi Technique , Intellectual Disability , Research Personnel/psychology , Female , Humans , Intellectual Disability/rehabilitation , Male
5.
Sensors (Basel) ; 19(5)2019 Mar 02.
Article in English | MEDLINE | ID: mdl-30832343

ABSTRACT

The Japanese Quasi-Zenith Satellite System (QZSS) satellite system has placed in orbit four satellites by October 2017. The Indian Regional Navigation Satellite System (IRNSS) system has launched the new satellite IRNNSS-11 in April 2018, completing seven operational satellites. Together with the GPS block IIF satellites and the Galileo satellites, four different global navigation satellite systems (GNSSs) are providing precise L5 signals on the frequency of 1176.45 MHz. In this contribution, we challenge the strength of the multi-GNSS model by analysing its single-frequency (L5), single-epoch (instantaneous) precise positioning capabilities under high-elevation masking (up to 40 degrees). With more satellites available, multi-GNSS real time kinematic (RTK) positioning is possible using L5-only signals with a high customary elevation mask. This helps to enable positioning in areas with constrained measurement geometry, and could significantly reduce the multipath effects in difficult measurement environments like urban canyons and mountainous areas. In this study, benefiting from the location of the Asia⁻Australia area, instantaneous multi-GNSS L5 RTK analysis is performed with respect to the ambiguity resolution and positioning performance. Formal results are shown and discussed for baselines located in different grids covering Australia, part of the Pacific Ocean, Indian Ocean and Asia, and empirical analysis is given for two baselines in Perth, Australia. Compared to the stand-alone cases, for baselines in Perth, it is shown that combining L5 signals from GPS/Galileo/QZSS/IRNSS significantly improves both the ambiguity success rates (ASR) and the positioning performance under high elevation mask. While the average single-system ASR is under 50% even with a low elevation mask of 10 degrees, combining all the four systems increases the ASR to above 95% under an elevation cut-off angles of 40 degrees. With an elevation mask of 40 degrees, using satellites from one system does not allow for meaningful positioning solutions of more than 8 h within the test day, while mm-to-cm level ambiguity-fixed standard deviations could be obtained based on the positioning results of almost the entire day when combining all the four systems. In addition to that, simulation was also performed for receivers with larger signal standard deviations, i.e., for low-cost receivers or receivers located in environments with larger multipath.

6.
Sensors (Basel) ; 18(11)2018 Nov 14.
Article in English | MEDLINE | ID: mdl-30441768

ABSTRACT

In this contribution, we study the phase-only ambiguity resolution and positioning performance of GPS for short baselines. It is well known that instantaneous (single-epoch) ambiguity resolution is possible when both phase and code (pseudorange) data are used. This requires, however, a benign multipath environment due to the severe effects multipath has on the code measurements. With phase-only processing, one would be free from such severe effects, be it that phase-only processing requires a change in receiver-satellite geometry, as a consequence of which it cannot be done instantaneously. It is thus of interest to know how much change in the relative receiver-satellite geometry is needed to achieve successful phase-only ambiguity resolution with correspondingly high precision baseline solutions. In this contribution, we study the two-epoch phase-only performance of single-, dual-, and triple-frequency GPS for varying time spans from 60 s down to 1 s. We demonstrate, empirically as well as formally, that fast phase-only very-precise positioning is indeed possible, and we explain the circumstances that make this possible. The formal analyses are also performed for a large area including Australia, a part of Asia, the Indian Ocean, and the Pacific Ocean. We remark that in this contribution "phase-only" refers to phase-only measurements in the observation model, while the code data are thus only used to compute the approximate values needed for linearizing the observation equations.

7.
Sensors (Basel) ; 18(4)2018 Apr 03.
Article in English | MEDLINE | ID: mdl-29614040

ABSTRACT

Precise point positioning (PPP) and its integer ambiguity resolution-enabled variant, PPP-RTK (real-time kinematic), can benefit enormously from the integration of multiple global navigation satellite systems (GNSS). In such a multi-GNSS landscape, the positioning convergence time is expected to be reduced considerably as compared to the one obtained by a single-GNSS setup. It is therefore the goal of the present contribution to provide numerical insights into the role taken by the multi-GNSS integration in delivering fast and high-precision positioning solutions (sub-decimeter and centimeter levels) using PPP-RTK. To that end, we employ the Curtin PPP-RTK platform and process data-sets of GPS, BeiDou Navigation Satellite System (BDS) and Galileo in stand-alone and combined forms. The data-sets are collected by various receiver types, ranging from high-end multi-frequency geodetic receivers to low-cost single-frequency mass-market receivers. The corresponding stations form a large-scale (Australia-wide) network as well as a small-scale network with inter-station distances less than 30 km. In case of the Australia-wide GPS-only ambiguity-float setup, 90% of the horizontal positioning errors (kinematic mode) are shown to become less than five centimeters after 103 min. The stated required time is reduced to 66 min for the corresponding GPS + BDS + Galieo setup. The time is further reduced to 15 min by applying single-receiver ambiguity resolution. The outcomes are supported by the positioning results of the small-scale network.

8.
BMC Psychiatry ; 17(1): 257, 2017 07 17.
Article in English | MEDLINE | ID: mdl-28716016

ABSTRACT

BACKGROUND: Persons with mild intellectual disability or borderline intellectual functioning are often studied as a single group with similar characteristics. However, there are indications that differences exist within this population. Therefore, the aim of this study was to identify classes of persons with mild intellectual disability or borderline intellectual functioning and to examine whether these classes are related to individual and/or environmental characteristics. METHODS: Latent class analysis was performed using file data of 250 eligible participants with a mean age of 26.1 (SD 13.8, range 3-70) years. RESULTS: Five distinct classes of persons with mild intellectual disability or borderline intellectual functioning were found. These classes significantly differed in individual and environmental characteristics. For example, persons with a mild intellectual disability experienced fewer problems than those with borderline intellectual disability. CONCLUSIONS: The identification of five classes implies that a differentiated approach is required towards persons with mild intellectual disability or borderline intellectual functioning.


Subject(s)
Intellectual Disability/classification , Learning Disabilities/classification , Adolescent , Adult , Aged , Child , Child, Preschool , Disability Evaluation , Female , Humans , Intellectual Disability/diagnosis , Learning Disabilities/diagnosis , Male , Middle Aged , Young Adult
9.
Sensors (Basel) ; 17(7)2017 Jun 26.
Article in English | MEDLINE | ID: mdl-28672862

ABSTRACT

As the navigation solution of exclusion-based RAIM follows from a combination of least-squares estimation and a statistically based exclusion-process, the computation of the integrity of the navigation solution has to take the propagated uncertainty of the combined estimation-testing procedure into account. In this contribution, we analyse, theoretically as well as empirically, the effect that this combination has on the first statistical moment, i.e., the mean, of the computed navigation solution. It will be shown, although statistical testing is intended to remove biases from the data, that biases will always remain under the alternative hypothesis, even when the correct alternative hypothesis is properly identified. The a posteriori exclusion of a biased satellite range from the position solution will therefore never remove the bias in the position solution completely.

10.
Sensors (Basel) ; 17(2)2017 Jan 30.
Article in English | MEDLINE | ID: mdl-28146107

ABSTRACT

The Indian Regional Navigation Satellite System (IRNSS) has recently (May 2016) become fully-operational and has been provided with the operational name of NavIC (Navigation with Indian Constellation). It has been developed by the Indian Space Research Organization (ISRO) with the objective of offering positioning, navigation and timing (PNT) to the users in its service area. This contribution provides for the first time an assessment of the IRNSS L5-signal capability to achieve instantaneous attitude determination on the basis of data collected in Perth, Australia. Our evaluations are conducted for both a linear array of two antennas and a planar array of three antennas. A pre-requisite for precise and fast IRNSS attitude determination is the successful resolution of the double-differenced (DD) integer carrier-phase ambiguities. In this contribution, we will compare the performances of different such methods, amongst which the unconstrained and the multivariate-constrained LAMBDA method for both linear and planar arrays. It is demonstrated that the instantaneous ambiguity success rates increase from 15% to 90% for the linear array and from 5% to close to 100% for the planar array, thus showing that standalone IRNSS can realize 24-h almost instantaneous precise attitude determination with heading and elevation standard deviations of 0.05 and 0.10 degrees, respectively.

11.
J Am Soc Nephrol ; 25(2): 390-8, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24158983

ABSTRACT

Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or physician care alone (control group). Median follow-up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but significant differences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins, active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR was 0.45 ml/min per 1.73 m(2) per year less than in the control group (P=0.01). In conclusion, additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD.


Subject(s)
Nurse Practitioners/statistics & numerical data , Patient Care Team , Renal Insufficiency, Chronic/nursing , Aged , Ambulatory Care Facilities/statistics & numerical data , Antihypertensive Agents/therapeutic use , Aspirin/therapeutic use , Biomarkers , Cholesterol, LDL/blood , Creatinine/blood , Female , Follow-Up Studies , Guideline Adherence , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/prevention & control , Male , Middle Aged , Office Visits/statistics & numerical data , Physicians , Proteinuria/epidemiology , Proteinuria/etiology , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/therapy , Renal Insufficiency, Chronic/urine , Treatment Outcome , Vitamin D/therapeutic use
12.
J Air Waste Manag Assoc ; 64(3): 272-9, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24701686

ABSTRACT

UNLABELLED: Vale Canada Limited owns and operates a large nickel smelting facility located in Sudbury, Ontario. This is a complex facility with many sources of SO2 emissions, including a mix of source types ranging from passive building roof vents to North America's tallest stack. In addition, as this facility performs batch operations, there is significant variability in the emission rates depending on the operations that are occurring. Although SO2 emission rates for many of the sources have been measured by source testing, the reliability of these emission rates has not been tested from a dispersion modeling perspective. This facility is a significant source of SO2 in the local region, making it critical that when modeling the emissions from this facility for regulatory or other purposes, that the resulting concentrations are representative of what would actually be measured or otherwise observed. To assess the accuracy of the modeling, a detailed analysis of modeled and monitored data for SO2 at the facility was performed. A mobile SO2 monitor sampled at five locations downwind of different source groups for different wind directions resulting in a total of 168 hr of valid data that could be used for the modeled to monitored results comparison. The facility was modeled in AERMOD (American Meteorological Society/U.S. Environmental Protection Agency Regulatory Model) using site-specific meteorological data such that the modeled periods coincided with the same times as the monitored events. In addition, great effort was invested into estimating the actual SO2 emission rates that would likely be occurring during each of the monitoring events. SO2 concentrations were modeled for receptors around each monitoring location so that the modeled data could be directly compared with the monitored data. The modeled and monitored concentrations were compared and showed that there were no systematic biases in the modeled concentrations. IMPLICATIONS: This paper is a case study of a Combined Analysis of Modelled and Monitored Data (CAMM), which is an approach promulgated within air quality regulations in the Province of Ontario, Canada. Although combining dispersion models and monitoring data to estimate or refine estimates of source emission rates is not a new technique, this study shows how, with a high degree of rigor in the design of the monitoring and filtering of the data, it can be applied to a large industrial facility, with a variety of emission sources. The comparison of modeled and monitored SO2 concentrations in this case study also provides an illustration of the AERMOD model performance for a large industrial complex with many sources, at short time scales in comparison with monitored data. Overall, this analysis demonstrated that the AERMOD model performed well.


Subject(s)
Air Pollutants/analysis , Models, Theoretical , Sulfur Dioxide/analysis , Environmental Monitoring , Metallurgy
13.
Sensors (Basel) ; 14(7): 12715-34, 2014 Jul 17.
Article in English | MEDLINE | ID: mdl-25036330

ABSTRACT

Direct geo-referencing is an efficient methodology for the fast acquisition of 3D spatial data. It requires the fusion of spatial data acquisition sensors with navigation sensors, such as Global Navigation Satellite System (GNSS) receivers. In this contribution, we consider an integrated GNSS navigation system to provide estimates of the position and attitude (orientation) of a 3D laser scanner. The proposed multi-sensor system (MSS) consists of multiple GNSS antennas rigidly mounted on the frame of a rotating laser scanner and a reference GNSS station with known coordinates. Precise GNSS navigation requires the resolution of the carrier phase ambiguities. The proposed method uses the multivariate constrained integer least-squares (MC-LAMBDA) method for the estimation of rotating frame ambiguities and attitude angles. MC-LAMBDA makes use of the known antenna geometry to strengthen the underlying attitude model and, hence, to enhance the reliability of rotating frame ambiguity resolution and attitude determination. The reliable estimation of rotating frame ambiguities is consequently utilized to enhance the relative positioning of the rotating frame with respect to the reference station. This integrated (array-aided) method improves ambiguity resolution, as well as positioning accuracy between the rotating frame and the reference station. Numerical analyses of GNSS data from a real-data campaign confirm the improved performance of the proposed method over the existing method. In particular, the integrated method yields reliable ambiguity resolution and reduces position standard deviation by a factor of about 0:8, matching the theoretical gain of √ 3/4 for two antennas on the rotating frame and a single antenna at the reference station.


Subject(s)
Geographic Information Systems/instrumentation , Lasers , Models, Theoretical , Reproducibility of Results
14.
Sensors (Basel) ; 13(7): 9435-63, 2013 Jul 22.
Article in English | MEDLINE | ID: mdl-23881141

ABSTRACT

The Chinese BeiDou system (BDS), having different types of satellites, is an important addition to the ever growing system of Global Navigation Satellite Systems (GNSS). It consists of Geostationary Earth Orbit (GEO) satellites, Inclined Geosynchronous Satellite Orbit (IGSO) satellites and Medium Earth Orbit (MEO) satellites. This paper investigates the receiver-dependent bias between these satellite types, for which we coined the name "inter-satellite-type bias" (ISTB), and its impact on mixed receiver attitude determination. Assuming different receiver types may have different delays/biases for different satellite types, we model the differential ISTBs among three BeiDou satellite types and investigate their existence and their impact on mixed receiver attitude determination. Our analyses using the real data sets from Curtin's GNSS array consisting of different types of BeiDou enabled receivers and series of zero-baseline experiments with BeiDou-enabled receivers reveal the existence of non-zero ISTBs between different BeiDou satellite types. We then analyse the impact of these biases on BeiDou-only attitude determination using the constrained (C-)LAMBDA method, which exploits the knowledge of baseline length. Results demonstrate that these biases could seriously affect the integer ambiguity resolution for attitude determination using mixed receiver types and that a priori correction of these biases will dramatically improve the success rate.

15.
Eur J Health Econ ; 24(1): 125-138, 2023 Feb.
Article in English | MEDLINE | ID: mdl-35412163

ABSTRACT

In healthcare systems with a purchaser-provider split, contracts are an important tool to define the conditions for the provision of healthcare services. Financial risk allocation can be used in contracts as a mechanism to influence provider behavior and stimulate providers to provide efficient and high-quality care. In this paper, we provide new insights into financial risk allocation between insurers and hospitals in a changing contracting environment. We used unique nationwide data from 901 hospital-insurer contracts in The Netherlands over the years 2013, 2016, and 2018. Based on descriptive and regression analyses, we find that hospitals were exposed to more financial risk over time, although this increase was somewhat counteracted by an increasing use of risk-mitigating measures between 2016 and 2018. It is likely that this trend was heavily influenced by national cost control agreements. In addition, alternative payment models to incentivize value-based health care were rarely used and thus seemingly of lower priority, despite national policies being explicitly directed at this goal. Finally, our analysis shows that hospital and insurer market power were both negatively associated with financial risk for hospitals. This effect becomes stronger if both hospital and insurer have strong market power, which in this case may indicate a greater need to reduce (financial) uncertainties and to create more cooperative relationships.


Subject(s)
Insurance Carriers , Motivation , Humans , Netherlands , Delivery of Health Care , Hospitals
16.
Kidney Int ; 82(6): 710-7, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22739979

ABSTRACT

Strict implementation of guidelines directed at multiple targets reduces vascular risk in diabetic patients. Whether this also applies to patients with chronic kidney disease (CKD) is uncertain. To evaluate this, the MASTERPLAN Study randomized 788 patients with CKD (estimated GFR 20-70 ml/min) to receive additional intensive nurse practitioner support (the intervention group) or nephrologist care (the control group). The primary end point was a composite of myocardial infarction, stroke, or cardiovascular death. During a mean follow-up of 4.62 years, modest but significant decreases were found for blood pressure, LDL cholesterol, anemia, proteinuria along with the increased use of active vitamin D or analogs, aspirin and statins in the intervention group compared to the controls. No differences were found in the rate of smoking cessation, weight reduction, sodium excretion, physical activity, or glycemic control. Intensive control did not reduce the rate of the composite end point (21.3/1000 person-years in the intervention group compared to 23.8/1000 person-years in the controls (hazard ratio 0.90)). No differences were found in the secondary outcomes of vascular interventions, all-cause mortality or end-stage renal disease. Thus, the addition of intensive support by nurse practitioner care in patients with CKD improved some risk factor levels, but did not significantly reduce the rate of the primary or secondary end points.


Subject(s)
Cardiovascular Agents/therapeutic use , Cardiovascular Diseases/nursing , Cardiovascular Diseases/prevention & control , Nurse Practitioners , Preventive Health Services , Renal Insufficiency, Chronic/nursing , Renal Insufficiency, Chronic/therapy , Risk Reduction Behavior , Aged , Cardiovascular Diseases/blood , Cardiovascular Diseases/mortality , Cardiovascular Diseases/physiopathology , Combined Modality Therapy , Disease Progression , Female , Glomerular Filtration Rate , Guideline Adherence , Humans , Kidney/physiopathology , Kidney Failure, Chronic/mortality , Kidney Failure, Chronic/nursing , Kidney Failure, Chronic/prevention & control , Linear Models , Male , Middle Aged , Motor Activity , Myocardial Infarction/mortality , Myocardial Infarction/nursing , Myocardial Infarction/prevention & control , Netherlands , Practice Guidelines as Topic , Proportional Hazards Models , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/mortality , Renal Insufficiency, Chronic/physiopathology , Risk Assessment , Risk Factors , Severity of Illness Index , Smoking Cessation , Stroke/mortality , Stroke/nursing , Stroke/prevention & control , Time Factors , Treatment Outcome , Weight Loss
17.
Humanit Soc Sci Commun ; 9(1): 223, 2022.
Article in English | MEDLINE | ID: mdl-35791377

ABSTRACT

Decades of techno-economic energy policymaking and research have meant evidence from the Social Sciences and Humanities (SSH)-including critical reflections on what changing a society's relation to energy (efficiency) even means-have been underutilised. In particular, (i) the SSH have too often been sidelined and/or narrowly pigeonholed by policymakers, funders, and other decision-makers when driving research agendas, and (ii) the setting of SSH-focused research agendas has not historically embedded inclusive and deliberative processes. The aim of this paper is to address these gaps through the production of a research agenda outlining future SSH research priorities for energy efficiency. A Horizon Scanning exercise was run, which sought to identify 100 priority SSH questions for energy efficiency research. This exercise included 152 researchers with prior SSH expertise on energy efficiency, who together spanned 62 (sub-)disciplines of SSH, 23 countries, and a full range of career stages. The resultant questions were inductively clustered into seven themes as follows: (1) Citizenship, engagement and knowledge exchange in relation to energy efficiency; (2) Energy efficiency in relation to equity, justice, poverty and vulnerability; (3) Energy efficiency in relation to everyday life and practices of energy consumption and production; (4) Framing, defining and measuring energy efficiency; (5) Governance, policy and political issues around energy efficiency; (6) Roles of economic systems, supply chains and financial mechanisms in improving energy efficiency; and (7) The interactions, unintended consequences and rebound effects of energy efficiency interventions. Given the consistent centrality of energy efficiency in policy programmes, this paper highlights that well-developed SSH approaches are ready to be mobilised to contribute to the development, and/or to understand the implications, of energy efficiency measures and governance solutions. Implicitly, it also emphasises the heterogeneity of SSH policy evidence that can be produced. The agenda will be of use for both (1) those new to the energy-SSH field (including policyworkers), for learnings on the capabilities and capacities of energy-SSH, and (2) established energy-SSH researchers, for insights on the collectively held futures of energy-SSH research.

18.
Environ Sci Technol ; 45(10): 4346-52, 2011 May 15.
Article in English | MEDLINE | ID: mdl-21488635

ABSTRACT

An aerosol time-of-flight mass spectrometer (ATOFMS) was used to detect trimethylamine (TMA) in 0.52-1.9 µm particles at urban and rural sites in Southern Ontario during the summer and winter of 2007. During the summer, TMA-containing particles were observed exclusively during high relative humidity or fog events at both the urban and rural sites. In the wintertime, greater concentrations of TMA-containing particles were linked to cloud processing of aerosol in air masses originating from over agricultural and livestock areas. A laboratory study revealed that, at high relative humidity (∼ 100%), gas phase TMA at concentrations ranging from 2 to 20,000 ppt partitions preferentially to acidic particles present in the ambient air. On the basis of the field and laboratory studies, it appears that gas phase TMA present in ambient air partitions onto pre-existing particles preferentially during periods of acidic cloud/fog processing, leading to the presence of TMA-containing particles in the 0.52-1.9 µm size range.


Subject(s)
Air Pollutants/analysis , Atmosphere/chemistry , Methylamines/analysis , Weather , Aerosols/analysis , Aerosols/chemistry , Air Movements , Air Pollutants/chemistry , Kinetics , Methylamines/chemistry , Phase Transition , Photochemical Processes
19.
S Afr Med J ; 111(10): 974-980, 2021 Oct 05.
Article in English | MEDLINE | ID: mdl-34949292

ABSTRACT

BACKGROUND: Delirium is associated with increased mortality and length of hospital stay. Limited data are available from HIV-infected acute hospital admissions in developing countries. We conducted a prospective study of delirium among acute medical admissions in South Africa (SA), a developing country with universal antiretroviral therapy (ART) access and high burdens of tuberculosis (TB) and non-communicable disease. OBJECTIVES: To identify the prevalence of, risk factors for and outcomes of delirium in HIV-infected individuals in acute general medical admissions. METHODS: Three cohorts of adult acute medical admissions to Groote Schuur and Victoria Wynberg hospitals, Cape Town, SA, were evaluated for prevalent delirium within 24 hours of admission. Reference delirium testing was performed by either consultant physicians or neuropsychologists, using the Confusion Assessment Method. RESULTS: The study included 1 182 acute medical admissions, with 318 (26.9%) HIV-infected. The median (interquartile range) age and CD4 count were 35 (30 - 43) years and 132 (61 - 256) cells/µL, respectively, with 140/318 (44.0%) using ART on admission. The prevalence of delirium was 17.6% (95% confidence interval (CI) 13.7 - 22.1) among HIV-infected patients, and delirium was associated with increased inpatient mortality. In multivariable logistic regression analysis, factors associated with delirium were age ≥55 years (adjusted odds ratio (aOR) 6.95 (95% CI 2.03 - 23.67); p=0.002), and urea ≥15 mmol/L (aOR 4.83 (95% CI 1.7 - 13.44); p=0.003), while ART use reduced risk (p=0.014). A low CD4 count, an unsuppressed viral load and active TB were not predictors of delirium; nor were other previously reported risk factors such as non-opportunistic acute infections or polypharmacy. CONCLUSIONS: Delirium is common and is associated with increased mortality in HIV-infected acute medical admissions in endemic settings, despite increased ART use. Older HIV-infected patients with renal dysfunction are at increased risk for inpatient delirium, while those using ART on admission have a reduced risk.


Subject(s)
Delirium/epidemiology , HIV Infections/complications , HIV Infections/drug therapy , Hospitalization , Adult , Anti-Retroviral Agents/therapeutic use , Female , HIV Infections/mortality , Humans , Male , Middle Aged , Prevalence , Prospective Studies , Risk Factors , South Africa/epidemiology
20.
Nephrol Dial Transplant ; 25(11): 3647-54, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20382963

ABSTRACT

BACKGROUND: Guidelines have set goals for risk factor management in chronic kidney disease (CKD) patients. These goals are often not met. In this analysis, we set out to assess the quality of risk factor management in CKD and to identify factors that determine the quality of care (QoC). For that purpose, baseline data of the MASTERPLAN (Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse practitioners) study have been used. MASTERPLAN is a multicentre study which evaluates the effect of a multifactorial intervention in prevalent CKD patients on cardiovascular (CV) events and progression of kidney failure. METHODS: QoC was quantified using a score based on the number of 11 defined treatment goals on target. The maximum score per patient was 11. RESULTS: The average (±SD) QoC score was 6.7 (±1.5). The average score per centre ranged from 5.9 to 6.9. In a multivariable analysis, centre proved to be a significant, independent determinant of QoC with a difference up to 0.7 between centres. This difference remained when adjustments were made for those risk factors primarily treated by pharmacotherapy. Other factors that were significantly related to the QoC were estimated glomerular filtration rate, Caucasian race, diabetes mellitus, diabetic nephropathy as cause of kidney disease and previous kidney transplantation. CONCLUSIONS: In CKD patients, risk factors for progression of kidney failure and CV events were inadequately controlled. Treatment centre proved to be an important determinant of QoC. This data may point towards the physician's interest and preference as important determinants of QoC. This is a potentially modifiable determinant of the quality of patient care [Trial registration ISRCTN registry: 73187232 (http://isrctn.org)].


Subject(s)
Kidney Diseases/therapy , Quality of Health Care , Adult , Aged , Cardiovascular Diseases/etiology , Chronic Disease , Female , Hospitals , Humans , Kidney Diseases/complications , Male , Middle Aged , Randomized Controlled Trials as Topic , Risk Factors
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