Search

With an increasingly ageing population, vulnerable to effects of a warming climate, it is critical that planners better understand how to minimise heat stress in urban environments. This Interface article discusses the potential of green infrastructure to moderate temperatures and improve thermal comfort for ageing populations. We highlight the need to integrate planning for green infrastructure with accessible design to improve opportunities for seniors to remain physically and socially active. We illustrate how our current research in Queensland, Australia integrates green infrastructure and accessibility as key concepts in a decision-making tool for auditing aged care facilities.

I have learned that we should never take the lives we lead for granted, and it is important for all of us to focus on the simple things that matter the most in everything we do. This is never more ...

Urban greenspaces provide diverse ecosystem functions, services and benefits to residents. Much commentary has been offered to date about citizens' demands for more urban greenspace. Less attention, however, has been given to the ‘supply side’ pressures experienced by local government in delivering urban greenspace, particularly in mid-sized cities. Greater attention to factors shaping supply is warranted, especially in the context of rapid population growth. By understanding how existing greenspace provision approaches can stymie the efforts of local government to meet citizens' needs, new approaches can be identified. This paper assesses several factors shaping urban greenspace provision in Surrey - a city within the Greater Vancouver area. Insights are derived from in-depth interviews with key stakeholders, public documents, and census and municipal data about parks and their context as a specific type of greenspace. Our findings suggest that governance tools, economy and property markets, and financial and natural resources manifest as core factors influencing urban greenspace provision in Surrey. A reliance on governance tools premised upon standards has created park provision paradoxes. Treating greenspace provision as a largely technocratic exercise may be limiting Surrey's ability to respond to changing politics, economics and population trends. We point to alternative approaches., Highlights • Providing urban greenspace is more than supplying land and revenue for facility development. • The clamour for more greenspace could be setting local governments up for some serious future policy deficiencies. • The tensions around land shortages, fiscal constraints and community expectations are driving the need for leadership.

The authors regret that the 104 articles referenced in Table 5 (p.93–95) were not repeated in our Reference List and as a result, were not being picked-up by citation databases and bibliometric software. In preparing our manuscript for publication, we were unaware of this risk and what is now apparent, an error in our paper. The authors would like to apologise for any inconvenience caused. 1: List of references selected for systematic quantitative literature Review

Volatile esters are amongst the most important yeast-derived flavor-active compounds produced during brewery fermentation. Dissolved oxygen concentration has long been recognized as an effector for...

Comprehensive sets of chemical, microbiological and sensory methods have long been available to characterize individual beers and explore the relationships between raw materials, process conditions and the outcome of the brewing process. Although the majority of major brewers are increasingly using quality assurance as opposed to quality control as the basis of operation, the need to use chemical analyses is still perceived as an essential prerequisite to brewing. The requirement to meet the various legislative codes and the need to manage the consistency of international brands arising from several individual breweries make the possession of robust analytical procedures essential. In many breweries there is a trend towards devolving traditional analytical tasks from central quality control laboratories manned by dedicated technicians to satellite stations, where the analyses needed to support production are performed directly by process workers. Parallel to these changes is a desire to achieve a greater understanding of the complex relationships between beer analysis and overall quality, in particular, the identification of markers that allow for the identification of processes such as beer ageing. This review summarizes the ways in which brewing analytical methods and the suppliers of analytical apparatus are evolving to meet the needs of the current modern industry. Copyright © 2012 The Institute of Brewing & Distilling

Repeated reuse or “serial repitching” of yeast between successive fermentations exposes brewing yeast cells to a number of biological, chemical, and physical stresses. It is generally accepted that...

A major concern for the brewing industry is achieving consistent fermentation cycle time without compromising the fermentation profile, the quality of the beer produced, or the yeast that is subseq...

The UK Hospital at Night (H@N) programme is hypothesised to improve efficiency of out-of-hours care. No studies have assessed a surgical programme or mechanisms of effect. This prospective study aimed to do so in a trauma and orthopaedic department over 10 weeks. Senior house officers recorded night shift activity. Mean time to attend referrals reduced from 29 to 15 minutes as a result of the programme (p=0.007). Workload and 30 day mortality and morbidity for hip fracture remained unchanged. The mechanisms underlying improvements are unclear, but may represent central organisation of workload.

The aim of this study was to determine the transcriptomic response of Saccharomyces pastorianus to environmental change during brewery propagation. Utilization of amino acids and fermentable carboh...

Amino acid utilization by yeast during brewer's wort fermentation influences both the fermentation performance and flavor profile of the finished product. To better understand the relationship betw...

Between May 2001 and May 2005, all 8834 adults admitted to our hospital with fractures to the limbs and pelvis were prospectively entered onto a database. Information was cross-referenced with the Office of National Statistics, and all patients who died during the study period were identified. Mortality rates were adjusted for age, gender and type of injury and cause of death was identified from hospital records. Neck of femur fractures accounted for 32% of admissions. Younger patients were more likely to be male and older patients more likely to be female. Overall 30-day and 1-year mortalities were 4.5 and 13%, respectively. Increased mortality was associated with age, male gender and fractures of the femur or pelvis.

This is the first study to use the English Indices of Multiple Deprivation 2007, the Government’s official measure of multiple deprivation, to analyse the effect of socioeconomic status on the incidence of fractures of the hip and their outcome and mortality. Our sample consisted of all patients admitted to hospital with a fracture of the hip (n = 7511) in Nottingham between 1999 and 2009. The incidence was 1.3 times higher (p = 0.038) in the most deprived populations than in the least deprived; the most deprived suffered a fracture, on average, 1.1 years earlier (82.0 years versus 83.1 years, p < 0.001). The mortality rate proved to be significantly higher in the most deprived population (log-rank test, p = 0.033), who also had a higher number of comorbidities (p = 0.001). This study has shown an increase in the incidence of fracture of the hip in the most deprived population, but no association between socioeconomic status and mortality at 30 days. Preventative programmes aimed at reducing the risk of hip fracture should be targeted towards the more deprived if they are to make a substantial impact.

Scale-up/scale-down techniques are vital for successful and safe commercial-scale bioprocess design and operation. An example is given in this review of recent studies related to beer production. Work at the bench scale shows that brewing yeast is not compromised by mechanical agitation up to 4.5 W/kg; and that compared with fermentations mixed by CO(2) evolution, agitation ≥ 0.04 W/kg is able to reduce fermentation time by about 20%. Work at the commercial scale in cylindroconical fermenters shows that, without mechanical agitation, most of the yeast sediments into the cone for about 50% of the fermentation time, leading to poor temperature control. Stirrer mixing overcomes these problems and leads to a similar reduction in batch time as the bench-scale tests and greatly reduces its variability, but is difficult to install in extant fermenters. The mixing characteristics of a new jet mixer, a rotary jet mixer, which overcomes these difficulties, are reported, based on pilot-scale studies. This change enables the advantages of stirring to be achieved at the commercial scale without the problems. In addition, more of the fermentable sugars are converted into ethanol. This review shows the effectiveness of scale-up/scale-down studies for improving commercial operations. Suggestions for further studies are made: one concerning the impact of homogenization on the removal of vicinal diketones and the other on the location of bubble formation at the commercial scale.

We performed a retrospective study of a departmental database to assess the efficacy of a new model of orthopaedic care on the outcome of patients with a fracture of the proximal femur. All 1578 patients admitted to a university teaching hospital with a fracture of the proximal femur between December 2007 and December 2009 were included. The allocation of Foundation doctors years 1 and 2 was restructured from individual teams covering several wards to pairs covering individual wards. No alterations were made in the numbers of doctors, their hours, out-of-hours cover, or any other aspect of standard patient care. Outcome measures comprised 30-day mortality and cause, complications and length of stay. Mortality was reduced from 11.7% to 7.6% (p = 0.007, Cox’s regression analysis); adjusted odds ratio was 1.559 (95% confidence interval 1.128 to 2.156). Reductions were seen in Clostridium difficile colitis (p = 0.017), deep wound infection (p = 0.043) and gastrointestinal haemorrhage (p = 0.033). There were no differences in any patient risk factors (except the prevalence of chronic obstructive pulmonary disease), cause of death and length of stay before and after intervention. The underlying mechanisms are unclear, but may include improved efficiency and medical contact time. These findings may have implications for all specialties caring for patients on several wards, and we believe they justify a prospective trial to further assess this effect.

A total of 146 patients were identified from a prospective database of all hip fractures over a 10-year period at a United Kingdom teaching hospital. The financial costs were calculated and analysed and then compared with the money recovered through the tariff produced by Payment by Results.A total of 62% of the study group were female; mean age of 79 years; mean length of stay of 39 days.Fractures occurred around total hip replacement (THR) in 63 cases, revision THR in 27 cases and hemiarthroplasty in 56 cases. Fixation of the fracture was performed in 61 cases, revision arthroplasty in 62 cases and 23 were treated non-operatively.The mean cost of treatment was £23,469 per patient (range £615–£223,000; median £18,031). Ward costs were responsible for 80.3%, theatre costs 5.7%, implants 6.7% and investigations 7.3%. The difference in cost was statistically significant when further surgery was required (p = 0.01) and length of stay was greater than 30 days (p < 0.0001), and when compared with the money recovered by the Trust(mean £3702; p < 0.0001). These results reveal the significant economic impact of treating this group of patients at specialist centres.

The fermentable carbohydrate composition of wort and the manner in which it is utilized by yeast during brewery fermentation have a direct influence on fermentation efficiency and quality of the final product. In this study the response of a brewing yeast strain to changes in wort fermentable carbohydrate concentration and composition during full-scale (3275 hl) brewery fermentation was investigated by measuring transcriptome changes with the aid of oligonucleotide-based DNA arrays. Up to 74% of the detectable genes showed a significant (p

Repeated reuse or “serial repitching” of yeast between successive fermentations exposes brewing yeast cells to a number of biological, chemical, and physical stresses. It is generally accepted that...

Summary Aims Recent studies have recommended the use of cephalo-medullary devices for the treatment of reverse oblique intertrochanteric femoral fractures (Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen, OTA/AO 31-A3). Both the proximal femoral nail (PFN) and the gamma nail (GN) have shown good outcome results but the results of treatment with the intramedullary hip screw (IMHS) have not been reported in the literature. Our aim was to review the outcomes of these unstable fractures treated with the IMHS implant at our institute. Methods Between 1999 and 2008, 6724 consecutive hip fractures were treated at our institute. There were 115 reverse oblique intertrochanteric fractures and 63 of these were treated with the IMHS. We retrospectively reviewed clinical and radiological records for these fractures treated with the IMHS. Follow-up duration ranged from 1 to 6 years. Results Amongst the 63 patients treated with the IMHS, 57 (90.5%) fractures were reduced satisfactorily with one poorly positioned hip screw and one breach of the anterior femoral cortex. The mean operative time was 115 min, 22 patients required a blood transfusion and 20 had postoperative medical complications. The major orthopaedic complications included two cases of malrotation, three nonunions and one traumatic periprosthetic fracture with a total failure rate of 7.9%. There were four cases of distal locking bolts breaking or backing out. The 30-day mortality was 6.5%. Conclusion The clinical and radiological outcomes achieved with the IMHS compare favourably to the results achieved with other cephalo-medullary devices. We consider the long IMHS a good implant for the treatment of these unstable fractures.

s / International Journal of Surgery 8 (2010) 501–578 526 Aim: Trainees need to acquire technical competencies to perform major procedures prior to taking up consultant posts. This study analyses the outcomes of infrainguinal bypass surgery performed by a consultant surgeon or supervised trainee,compared with those performed by unsupervised senior vascular trainees. Methods: Data were collected on all patients who underwent infrainguinal bypass grafting at our instituition between 2000 and 2009.30-day mortality,limb salvage,graft patency rates,and overall survival was assessed. Results: 500 infrainguinal bypass procedures were performed. 377 cases were performed by the consultant, or a supervised trainee (17% above knee, 37% below knee, 46% distal), and 72 were performed by unsupervised vascular trainees (17% above knee, 47% below knee, 37% distal). Vein graft was used in 76% and 80% cases respectively. 30 day mortality was significantly higher after operation by a consultant, 6.6%, compared to a trainee 0% (p < 0.0001 c2). Limb salvage (e17%)and graft patency rates (e66%)were comparable, as was overall survival(consultant vs trainee; at 2 year 75% vs 72% p 1⁄4 0.997 Log rank). Conclusion: Satisfactory patient outcomes after infrainguinal bypass surgery can be achieved by unsupervised experienced vascular trainees. The higher 30-day mortality in the consultant operated group probably reflects appropriate case selection, with training allocated to fitter patients. REALLOCATION OF FOUNDATION PROGRAMME DOCTORS FROM TEAMS TO WARDS REDUCES MORTALITY FROM PROXIMAL FEMORAL FRACTURE J.M. Findlay, M.J. Keogh, C. Boulton, D.P. Forward, C.G. Moran. Queen's Medical Centre, Nottingham, UK Introduction: Proximal femoral fractures are common and carry a 30 day mortality of 10-20%. Alternative models of care have been described, however, no studies have assessed the re-allocation of junior doctors, who often care for patients on numerous wards. Methods: This was a retrospective study of 559 consecutive patients admitted to a UK university teaching hospital with proximal femoral fracture. Foundation years 1 and 2 were re-allocated from consultant teams to wards; surgical trainees remained with teams. No alterations were made in numbers of doctors, shift patterns, hours, or any other factor associated with outcome. Results: Mortality reduced from 13.9% to 7.2% (p 1⁄4 0.009) and occurred later (17.0 days versus 13.4; p 1⁄4 0.022) after intervention. There were no significant differences in 20 patient, fracture or operative factors associated with adverse outcome. There were no differences in cause of death, delay to operation, length of stay and post-operative complications, except wound haematomas which increased from 0.0% to 2.0% (p 1⁄4 0.035) Conclusion: Reallocation of Foundation doctors from teams to wards reduces and delays mortality in proximal femoral fracture, a model potentially applicable to other specialties. The mechanisms are unclear, but may include improved efficiency and contact time allowing more proactive and reactive care. CAN PREOPERATIVE RADIOGRAPHIC MARKERS BE USED TO PREDICT LOOSENING OF TOTAL HIP ARTHROPLASTIES? M.F. Nixon , N. Howard , G.J.S. Taylor . 1 Countess of Chester Hospital; 2 Glenfield Hospital Leicester 91 patients with a cemented Charnley Elite plus total hip arthroplasty were reviewed to assess whether preoperative radiological markers could predict aseptic loosening. We compared 36 patients with post operative radiological signs of aseptic loosening and 55 patients with a well fixed stable femoral component. Preoperative x rays were assessed blindly in a standardised fashion for;1) Cortex ratio medial femoral cortex 50 mm below the lesser trochanter divided by thickness of the shaft. 2) Canal ratio Thickness of intramedullary canal at the level of the greater trochanter divided by that at the isthmus. 3) The Bombelli biological classification of OA which assesses the degree of osteophyte formation (atrophic, normotrophic and hypertrophic). Patients with loosening had narrower femoral cortices (p 1⁄4 0.05) and were more likely to have presented with atrophic osteoarthritis (p 1⁄4 0.05). The canal ratio however was not significantly related. LOCALISATION AND IDENTIFICATION OF BACTERIA IN THE SKIN OF PATIENTS UNDERGOING PRIMARY KNEE AND HIP REPLACEMENT SURGERY AFTER SURGICAL SKIN PREPARATION L. Glen, R. Bayston, B. Scammell, W. Ashraf. BRIG department of Orthopaedic and Accident Surgery, QMC, Nottingham Background: Arthroplasty infection rates are up to 2.5%1.Surgical skin preparation reduces surgical site infections2. However skin preparation removes only bacteria from the surface of the skin3, leaving deeper layers colonised. Methods: After informed consent, 22 patients participated (13 knees, 9 hips). A swab and skin biopsy was taken after skin preparation with alcoholic povidone-iodine. The biopsy was cut aseptically in half. One half was disrupted using forceps. This half and the swab were cultured separately anaerobically at 37oC. Half of the biopsy was frozen in isopentane, cryosectioned and Gram stained. Results: 7 of 20 swabs (2 S.epidermidis, 3 P.acnes, 1 S.aureus and 1 with both S.epidermidis and P.acnes) and10 of 22 biopsies grew bacteria (4 P.acnes, 3 S.epidermidis, 2 S.aureus and 1 S.capitis). Gram positive bacteria were seen for all biopsy sections. Discussion: Selwyn and Ellis (1972) using iodine found over 99% of bacteria are removed from epidermis. In this study 35% remained on the surface when using povidone-iodine and 46% in deeper layers. 1. HPA, 2009. http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1259151994683 accessed 06/01/2010 2. NICE, 2008. http://www.nice.org.uk/nicemedia/ pdf/CG74FullGuideline.pdf accessed 06/01/2010 3. Lowbury E J. 1961. Journal of clinical pathology 14:85-90. 4. Selwyn S, Ellis H. 1972. Br Med J 1:136-140. SAFETY OF AUTOLOGOUS BLOOD TRANSFUSION FOLLOWING INTRAOPERATIVE INTRAARTICULAR ROPIVACAINE ANAESTHESIA E. Ieong, D. Gordon, C. Willis-Owen, N. Somashekar, D. HoulihanBurne. Hillingdon Hospital Introduction: Intraoperative local anaesthetic injection enables early mobilisation after total knee arthroplasty (TKA). Autologous blood transfusion reduces requirements, and complications, of allogenic blood transfusions. Currently these two techniques are not used together, due to concern of intravenous administration of toxic doses of local anaesthetic from the reinfusion drain. This pilot study investigates the safety of using these two techniques together.