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New evidence was sought for sub-pan silcrete formation along the southern margin of Ntwetwe Pan in the Botswana Makgadikgadi basin. This was achieved by integrating drillhole and surface sample descriptions with element and isocon analysis. The silcrete deposit which lies ~1.0 m below the pan surface, comprises Ntane sandstone fragments and detrital infill, cemented by amorphous silica. The deposit probably evolved during sequential periods of palaeo-lake infilling and drying since at least the Mid-Pleistocene. Changes in basin water pH brought about during fresher water infill interspersed with brine evapo-concentration and later evaporative pumping, induced the mobilisation and precipitation of the silica cement immediately below the pan floor.

A likely consequence of the discontinued distribution and sale of the HVAD System (Medtronic, Minneapolis, MN) will be an increase in replacement with the HeartMate 3 (Abbott, Chicago, IL) left ventricular assist device when device exchange is necessary. If part or all of the HVAD 10-mm-diameter outflow graft is retained during replacement, the HeartMate 3 will have to run at a higher speed than it would with its 14-mm-diameter graft.A steady-state, in vitro study was run with 250-mm-long samples of HVAD, HeartMate 3, and half-HVAD/half-HeartMate 3 grafts and additionally 125- and 375-mm-long samples of the HVAD graft. Flows of 3.0, 3.9, 4.3, 4.7, and 6.0 L/min were applied to encompass expected clinical conditions.At typical and high flow rates of 4.3 and 6.0 L/min, HeartMate 3 rotor speeds with the full HVAD graft had to be increased relative to those with the HeartMate 3 graft from 5350 to 5700 and 6350 to 6900 rpm, respectively, with power consumption increases from 3.7 to 4.3 W (16%) and 5.5 to 6.8 W (24%), respectively.The study did not elucidate a severe consequence of using a remnant HVAD graft during pump exchange, but the incremental risks of a higher rotor speed, disadvantage to the patient in battery runtime, and the general benefit of complete conversion to the HeartMate 3 graft should be balanced against other procedural considerations. Complete graft replacement during HVAD-to-HeartMate 3 conversion remains the preferred approach from an engineering point of view.

A 13-year-old male asthmatic presented to the general paediatric clinic with papilloedema identified following a check-up with his optician due to blurred vision. His asthma was well controlled on a moderate dose of inhaled corticosteroid and there had been no recent increase or decrease in the dose. A diagnosis of benign intracranial hypertension (BIH) was made based on a raised cerebrospinal fluid opening pressure, papilloedema, a normal neurological examination and normal neuroimaging. The only associated risk factor was his inhaled corticosteroids. He was commenced on acetazolamide and the inhaled corticosteroid dose was reduced, resulting in resolution of his papilloedema. This case serves to highlight that steroid side effects including BIH may occur at moderate doses of inhaled corticosteroids and that inhaled corticosteroid dose should be regularly reviewed and decreased to the lowest dose that maintains asthma control.

This paper discusses relevant research on structured therapy techniques used in the course of cognitive behavioral therapy (CBT) that are helpful in treating older adults with depressive disorders. These findings are compared and contrasted with clinical observations pertinent to the identification of moderator/mediator and other contextual factors critical to the efficacy of CBT for the treatment of this population. While some of these techniques may be viewed as a specific type of intervention in their own right (e.g., Behavioral Activation and Lifeskills Approach), their underlying theory and specific operations are consistent with the underpinnings of other cognitive and behavioral strategies and may be frequently juxtaposed within a CBT framework, depending on the nature of the problem and the specific available resources. Several common issues identified as being problematic for clinicians new to clinical work with older adults are highlighted, and useful information on how to adapt/modify traditional CBT approaches to augment treatment outcome with older adults is provided. Clinicians who use CBT will be familiar with most components discussed, but one novel augmentation towards the development of an age-appropriate format of CBT, termed Lifeskills Approach, is included. In this approach, clinicians are encouraged to identify and incorporate evidence of prior successful coping strategies to challenges that occur across the lifespan. This approach values and respects how clients have overcome aversive life experiences to facilitate attentional deployment away from a narrative of failure to one of resilience and self-acceptance, thereby down-regulating emotional distress. An important consideration discussed is how to use behavioral activation effectively, particularly with persons who have mild cognitive impairment (MCI) or are in the early stages of dementia.

Sleep is disturbed by a range of factors across the lifespan. However, older adults experiencing disruptions in their sleep are often simultaneously contending with a range of comorbid medical and psychiatric conditions that compound the biological changes in sleep that commonly occur with age. Cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard, nonpharmacological intervention for sleep disturbances, and is a cost-effective treatment approach that can occur in either individual or group format. It has also been shown effective in older adults with medical, psychiatric, and cognitive comorbid disorders. This review highlights the success of CBT-I with older adults, as well as studies that illustrate the use of alternative delivery methods and treatment modifications for complex clinical presentations.

Across much of southern Africa’s savanna wildernesses, wildfires burn unchecked. This is particularly true in the woodland savannas of northern Botswana, where wildfires originate outside of management activities, and are left to burn uncontrolled, because of limited resources and remoteness. There is concern that severe annual wildfires are resulting in the ‘savannisation’ of large tracts of wooded land across forest reserves, protected areas and surrounding wilderness areas. Because the current fire regime is unknown, management interventions are hard to introduce. We examine the recent 20-year (2001–2020) fire history in northern Botswana using MODIS satellite derived fire products to reveal fire frequency and seasonality. Six wildfire hotspots are identified for exploration of fire frequency and possible origins. Annual fire frequencies are far higher than would be expected without anthropogenic ignition. Extensive areas in some hotspots are shown to have burned between 14 and 16 out of the 20-year period. Fires peak in September, several weeks before the onset of the rainy season and associated lightning strikes, and when the fuel load is at its maximum and conditions at their driest. Adaptive fire management practices, such as those being followed in neighbouring South Africa and elsewhere should inform Botswana’s fire management policies.

We assess outcomes of endoscopic orbital decompression for Graves’ ophthalmopathy. A review of endoscopic orbital decompressions of the medial and partial inferior wall between July 2004 and July 2017 was carried out. Outcome was assessed by comparing pre- and post-operative measurements of exophthalmometry and visual acuity. Results were evaluated by repeated measures analysis of variance. A total of 41 orbits in 25 patients underwent endoscopic orbital decompression for Graves’ ophthalmopathy in the time period; however, six orbits in three patients had insufficient data for inclusion. Eleven patients required concurrent septoplasty to allow access. Measurements were taken at a mean of 11 days, 32 days, and 95 days post-operatively. Reduction in mean proptosis was 2.81 mm at 1-month post-decompression and 3.26 mm at 3 months. There was no significant difference between those treated for compressive optic neuropathy compared with those treated for cosmetic reasons. Colour vision by Ishihara plate improved significantly by a mean score of 2.67 post-operatively. Using LogMAR conversion for visual acuity, measured by a best-corrected Snellen chart, improvement of 0.18 was achieved at 1-month post-decompression, equivalent to approximately two lines on the Snellen chart. There was minimal (0.04) further improvement at 3 months. The improvement in visual acuity was greater in cases treated for compressive optic neuropathy than cosmesis, but this did not reach statistical significance (p = 0.06). Three cases required revision surgery. Diplopia disimproved or developed in four cases and squint surgery was required in three cases. Endoscopic orbital decompression offers an effective, safe and minimally invasive treatment for Graves’ ophthalmopathy. There is a trend towards continued improvement in outcomes over the course of 3 months post-operatively.

© 2020 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's AssociationIntroduction: Non-pharmacological treatments (NPTs) have the potential to improve meaningful outcomes for older people at risk of, or living with dementia, but research often lacks methodological rigor and continues to produce mixed results. Methods: In the current position paper, experts in NPT research have specified treatment targets, aims, and ingredients using an umbrella framework, the Rehabilitation Treatment Specification System. Results: Experts provided a snapshot and an authoritative summary of the evidence for different NPTs based on the best synthesis efforts, identified main gaps in knowledge and relevant barriers, and provided directions for future research. Experts in trial methodology provide best practice principles and recommendations for those working in this area, underscoring the importance of prespecified protocols. Discussion: We conclude that the evidence strongly supports various NPTs in relation to their primary targets, and discuss opportunities and challenges associated with a unifying theoretical framework to guide future efforts in this area.

Study Objectives This pilot randomized controlled trial (RCT) was conducted to assess the preliminary effects of Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI) delivered by trained research staff in comparison to a sleep hygiene pamphlet control and to assess moderators of treatment effect in patients with breast cancer undergoing chemotherapy. Methods Of 74 participants recruited, 37 were randomized to BBT-CI and 37 were randomized to the control condition. Trained staff members delivered the intervention during chemotherapy treatments to reduce patients’ burden. Insomnia was assessed with the Insomnia Severity Index (ISI), anxiety was assessed with the Spielberger State-Trait Anxiety Inventory, symptom burden was assessed with the Symptom Inventory (SI), and study staff recorded previous treatments and surgeries received by patients. Results Patients randomized to BBT-CI showed significantly greater improvements in their ISI scores compared to the sleep hygiene group. Additionally, several treatment moderators were identified. The effect of BBT-CI was greater among individuals with lower baseline state-trait anxiety, with previous surgery for cancer, and with higher baseline somatic symptom severity. Conclusions BBT-CI shows preliminary efficacy compared to the sleep hygiene handout on insomnia in cancer patients undergoing chemotherapy. A large-phase III RCT needs to be conducted to replicate the preliminary findings.

Optimum gestational weight gain (GWG) is vital for successful pregnancy outcomes. However, pregnant women often feel misinformed or that interventions will not meet their needs; hence, many services report poor attendance and/or engagement [1]. PPI aims to empower those affected by an intervention, to participate in shaping the intervention [2,]. The aim of this study was to conduct PPI to gain insight into the experiences of weight management advice received during pregnancy - to inform future interventions.We recruited two PPI representatives (PLRs) - former patients, who assisted in all aspects of the study: design, interview questions, recruitment of PPI participants and collection/analysis of feedback. The PLRs approached pregnant/postnatal women to participate. During the PPI workshop procedure, women gave verbal consent for their views and possible verbatim quotes to be used in publications/grant applications. Feedback was collected via notetaking during four group discussions (approximately 1 hour in duration), all held in community locations - two in Liverpool (n = 10 & 5), two in Derry (n = 7 & 9) and an interview (n = 1, in Derry). The research team collated the transcripts, subjected them to repeated reading and thematic analysis, informed by Braun and Clarke's step-by-step guide [3].Three themes were identified: 1) Weight gain is inevitable in pregnancy; 2) Healthy eating advice is important but lacks consistency and depth; 3) Expectations regarding knowledge/support. Regarding theme 1: Most women viewed weight gain as an inevitable part of pregnancy, with variable amounts of weight gain being reported. Some women viewed pregnancy as an opportunity to ‘relax’ previous diets - using pregnancy as an excuse to gain weight ‘without feeling guilty’. Women were only weighed at their initial appointment but had no opposition to routine weighing throughout pregnancy or for research, providing they were informed about its significance and importance: “It would be ok to be weighed if it is for baby's health.”However, they were opposed to ‘weight watching’: “We live in a society where weight is such a big issue. It can be difficult putting on weight and thinking about it too much and stressing yourself.”Despite known risks associated with excess GWG, women considered weight gain ‘inevitable’, so deemed weight monitoring unnecessary. NICE guidance [4] advises against routine weighing which ‘may produce unnecessary anxiety with no added benefit’.However, regular weighing may help to avert excessive GWG, if conducted sensitively and with appropriate dietary/lifestyle support, versus weighing without intervention, which may cause ‘stress’.

America’s population of adults age 65 and older is projected to increase from 40.3 million to 72.1 million between the years 2010 and 2030. This increase has ignited the ongoing discussion around creating effective mechanisms and sufficient resources for older adults suffering from a range of mental health needs, both in community and residential care settings. Although the percentage of older adults with a diagnosable mental disorder is lower than those in younger age groups, they often present with comorbid physical and cognitive challenges that make treatment more complicated. Effective strategies to support the mental health of older adults in both home and residential community settings will go far in helping older adults age successfully and access needed mental health support.

Maternal BMI has been shown to be inversely correlated with vitamin D status (25-hydroxyvitamin D (25(OH)D) concentrations) during pregnancy. Pregnant women with obesity and with vitamin D deficiency are at risk of many adverse health outcomes in pregnancy.The aim of this study was to examine differences in maternal vitamin D status across normal weight, overweight and obese pregnant women in early pregnancy.Data collected at baseline from a double-blind randomised vitamin D intervention study (MO-VITD) were used. Pregnant women without pregnancy complications, aged > 18 years and having a singleton pregnancy were recruited between January 2016 and August 2017 at antenatal clinics in the Western Health and Social Care Trust, Northern Ireland. Non-fasting blood samples were collected at 12 weeks gestation and analysed for total serum 25(OH)D, using liquid chromatography tandem mass spectrometry. Data from 239 pregnant women (80 normal weight, 79 overweight, 80 obese) were included in the current analysis.The mean ± SD 25(OH)D concentration of all pregnant women at 12 weeks gestation was 52.0 ± 21.6 nmol/L. Women classed as obese or overweight had significantly lower 25(OH)D concentrations compared to women of normal weight (48.8 ± 20.3 vs 49.8 ± 20.4 vs. 57.5 ± 23.1 nmol/L, P = 0.019; obese, overweight, normal weight respectively). A total of 45% of all pregnant women were found to be either vitamin D deficient (25(OH)D < 25nmol/L; 13%) or insufficient (25–50 nmol/L; 32%) in early pregnancy. BMI was significantly negatively correlated with 25(OH)D concentrations (r = -0.168; P = 0.009). Regression analyses showed that BMI (β = -0.165; P = 0.006), season (β = 0.220; P = < 0.0001), supplement use (β = -0.268; P < 0.0001) and a sun holiday within the previous 6 months (β = -0.180; P = 0.010) were significant predictors of 25(OH)D concentrations. In early pregnancy, 62% of pregnant women reported using a supplement containing vitamin D and 38% reported no supplement use. Supplement users had a significantly higher vitamin D status than non-supplement users in all BMI categories but overall, 37% of supplement users were still classified as vitamin D insufficient. Vitamin D status was significantly lower in winter months compared to summer months. In early pregnancy, especially during winter months, pregnant women with obesity, particularly non-supplement users, are at higher risk of low vitamin D status. Based on the lower vitamin D status observed in early pregnancy in obese women, the effect of BMI on vitamin D supplementation throughout pregnancy needs to be examined.

Pregnant women who are overweight/obese are particularly vulnerable to vitamin D insufficiency owing to higher physiological requirements and lower status (25(OH)D concentrations) associated with obesity. Achieving adequate maternal vitamin D status with current recommendations (10μg/d) remains controversial.This study examined supplementation effects (10μg-vs-20μg vitamin D3/d) throughout pregnancy (12 weeks gestation until delivery) on vitamin D status of normal weight, overweight and obese pregnant women and on cord blood, using a double-blind randomised vitamin D intervention study (MO-VITD). 240 pregnant women were recruited throughout the year at antenatal clinics in Northern Ireland (equal numbers of normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (> 30kg/m2)). Non-fasting maternal blood samples were collected at 12, 28 and 34–36 weeks gestation and from the umbilical cord after delivery and analysed for total serum 25(OH)D using LCMS.A high prevalence of vitamin D insufficiency (25–50nmol/L) was found in the 1st trimester in both treatment groups (41.5% and 48.8%; 10μg vs. 20μg respectively). Maternal 25(OH)D concentrations increased from the 1st to 3rd trimester in both the 10μg/d and 20μg/d groups, with a higher increase in the 20μg group (17.1 ± 24.7 and 28.8 ± 33.3nmol/L, P = 0.002). There was no difference in cord blood 25(OH)D concentrations between treatment groups.Women who started pregnancy with insufficient 25(OH)D concentrations remained insufficient throughout pregnancy in the 10μg/d group (49.9 ± 28.2nmol/L at trimester 3). In the 20μg/d group, women starting pregnancy as insufficient achieved levels of sufficiency in the 2nd (58.9 ± 30.6nmol/L) and 3rd (64.0 ± 35.9nmol/L) trimesters. Women who started pregnancy with sufficient vitamin D status (25(OH)D > 50nmol/L), maintained levels of sufficiency throughout pregnancy irrespective of treatment group (83.1 ± 24.4 and 96.7 ± 30.7 at trimester 3 in 10μg/d and 20 μg/d groups respectively); findings were similar across all BMI categories.Obese women who started pregnancy with an insufficient status were found to have deficient cord blood (25(OH)D < 25 nmol/L) in both the 10μg/d and 20μg/d groups (19.4 ± 20.2 vs. 19.5 ± 9.4nmol/L respectively), whilst obese women who started pregnancy with sufficient status (> 50nmol/L) had cord blood concentrations considered insufficient (40.2 ± 18.4 vs. 44.2 ± 15.6nmol/L; 10μg vs. 20μg groups respectively).Based on our findings of the high prevalence of vitamin D insufficiency in early pregnancy, maternal vitamin D supplementation of 20μg/d is advisable to maintain maternal vitamin D status in pregnant women in Northern Ireland.

Introduction A substantial proportion of older adults will experience depression (including major depressive disorder and subsyndromal depressive symptoms), yet depression remains underdiagnosed and undertreated among older adults. Behavioral Activation is an effective, empirically-validated, first-line treatment for mild to moderate depression. Behavioral activation is a patient-centered intervention designed to decrease depressive behavior (e.g. social isolation, physical inactivity) and increase engagement in pleasurable activities (e.g. hobbies, family time). The objective of this scoping review is to evaluate the gaps in the literature and knowledge base regarding the implementation contexts, target populations, delivery modalities, assessment methods, and effectiveness of behavioral activation as a treatment for depression and/or anxiety among older adults, including both inpatient and outpatient settings. Methods We performed a scoping review and searched for peer-reviewed articles published from 1990 to 2020. The keywords and their combinations (e.g., depression, anxiety, elder(s), elderly, geriatric, older adult(s), age, aged, aging, behavio(u)ral activation) were used in search engines including the following but not limited to PubMed, PsycINFO, and Cochrane. Our search strategy identified 423 results; after removing duplicates, 232 results remained. Currently, we are evaluating the titles and abstracts using broad inclusion criteria to ensure that all relevant behavioral activation relevant to geriatric depression and/or anxiety are included. All types of studies and publications (e.g. randomized clinical trials, cohort studies, case controls, reviews, etc.) that focus on behavioral activation as an intervention or primary focus are being included in this comprehensive search. Studies have to include participants > 50 years old with either clinically diagnosed depression and/or anxiety at or above a pre-defined cut-point on a validated symptom scale (e.g., PHQ-9: >5 and GAD-7: >5). Results This scoping review will chart the landscape of literature relevant to behavioral activation for older adults with depression and/or anxiety. The literature will be reviewed in terms of study setting (e.g., community or outpatient settings, inpatient psychiatric units, assisted living facilities); study type (including randomized clinical trials, as well as observational studies, cohort studies, case controls, cross sectional, etc.); mode, frequency, and duration of intervention delivery; type and training of providers; assessment methods; and outcomes. Reviews will be examined for themes and consistency in synthesis of findings. Particular attention will be paid to identifying gaps in the literature where further work is needed to broaden the reach and impact of this promising intervention. Conclusions Scoping reviews represent a compelling method for evaluating existing literature and identifying gaps for future study. The present scoping review will synthesize the identified literature, in the hope of helping not only clinicians who work closely with older adults, but also researchers wishing to pursue studies in this area. Given a burgeoning older adult population and a paucity of geriatric mental health providers, clinical guidelines offering alternative nonpharmacologic therapy can be effective and cost-effective for clinicians and healthcare systems. Given the COVID-19 pandemic and the consequent escalation in social isolation among older adults, it is also hoped that this scoping review will identify promising avenues and methods for adapting behavioral activation in myriad ways—i.e., through implementation via telehealth platforms—to the older adult population. Funding Not applicable

Improving the sleep of older adults with mild cognitive impairment (MCI) represents a first step in discovering whether interventions directed at modifying this risk factor also have the potential to alter the cognitive decline trajectory.A six-session, adapted version of a cognitive behavioral therapy for insomnia (CBT-I) was administered to older adults (N = 28; 14 per group) with MCI across two residential facilities. Participants were randomly assigned to either the sleep intervention or an active control group and completed a neuropsychological battery at three time points (e.g., baseline-T1, post-intervention-T2, 4 month follow-up-T3).Results showed a significant improvement in sleep and a change (p .05) on a key measure of executive functioning sub task of inhibition (Condition 3 of D-KEF Color-Word Interference Test), a positive trend on the inhibition-switching task (p .10; Condition 4 of D-KEF Color-Word Interference Test), an no change in a measure of verbal memory (HVLT-R Delayed Recall) compared with the active control group.CBT-I is a nonpharmacological intervention that has the potential to cognitively benefit individuals with MCI suffering from comorbid insomnia.Results suggest that a non-pharmacological intervention to improve sleep in older adults with MCI also improve cognitive functioning. Further exploration of the mechanisms underlying these improvements is warranted.

Older adults frequently suffer from sleep disturbances. In addition, with increasing age such disturbances may accompany mild cognitive changes that are symptomatic of a range of neurodegenerative conditions. There is increasing evidence that sleep may represent a prodromal symptom, risk factor or agitator of further decline in cognitive functioning of the older adult. Current research is focused on understanding the impact that effective sleep treatments have on a range of psychological and cognitive variables.

Energy sustainable strategies in Europe advocate increasing the share of electricity generated from renewable energy sources (RES-E) in response to the need of reducing Green House Gas (GHG) emissions. RES-E production is considered to have a prominent role in the crusade against climate change and in Europe’s energy security. Renewable energy technology (RET) deployment is also sought for promoting a large number of jobs. Nevertheless, the exact number of jobs created is presented with large discrepancies across recent studies. The use of different methodologies but also the consideration of different assumptions even when the same methodology is applied has implications on the variability of employment estimates. This paper is aimed at providing a clearer understanding of what are the implications of government support for RES-E on jobs, and to see if current claims over employment benefits are too optimistic or even pessimistic in light of these findings. Taking Portugal as a case study, this paper conveys an assessment of the impact of renewable energy targets for electricity generation on employment for the years 2008–2020. The analysis is conducted by means of the Input-Output (IO) approach (quantity and price models) and considering the different life cycle stages of RES-E and conventional electricity (CE) power plants.

With an aging population that continues to grow into the 21stcentury, financial abuse targeting older adults has become an increasingly burdensome issue. Financial abuse in older adults costs them billions of dollars annually in the United States and is common,affecting approximately 1 of every 18 cognitively intact, community-dwelling older adults each year (Burnes, et al 2017). Financial scams perpetrated by persons generally unknown to the victims make up a subset of the overall burden of financial abuse in older adults. In addition to financial costs of being targeted or victimized by a scam, there are associations with mortality, hospitalizations, physical and mental health problems as well. The problem is likely larger than is realized, due in part to the underreporting of these crimes, which are often considered “low risk” for seasoned criminals due in part to the difficulties associated with prosecuting such crimes. This session will provide an overview of scope of the problem of financial scams targeted at older adults, review the recent literature on the topic, consider the factors that make the older adult population particularly vulnerable to financial abuse and particularly scams, discuss the psychiatric ramifications of being a victim of financial abuse, detail a multitude of the most prominent scams targeting older adults occurring recently, and hope to provide resources such that we can educate our patients and their families on the topic of financial scams in the older population. The session will include a rich case detailing an example of how a financial scam in an older adult led to a myriad of intertwined sequelae.

ObjectiveTo conduct patient and public involvement (PPI) to gain insight into the experience of healthy eating and weight management advice during pregnancy.DesignPPI in the planning and development of health interventions, aiming to ensure patient-centred care. Optimum nutrition and weight management are vital for successful pregnancy outcomes, yet many services report poor attendance and engagement.SettingCommunity venues in Liverpool and Ulster (UK).ParticipantsTwo PPI representatives were involved in all aspects of the study: design, interview questions, recruitment and collection/analysis of feedback.InterventionFeedback was collected via note taking during group discussions, two in Liverpool (n = 10 & 5); two in Ulster (n = 7 & 9) and an interview (n = 1, in Ulster).Main Outcome MeasuresTranscript data were collated and thematic analysis was applied in analysis.ResultsThematic analysis identified three themes: (i) weight gain is inevitable in pregnancy; (ii) healthy eating advice is important but currently lacks consistency and depth and (iii) expectations regarding the type of knowledge/support.ConclusionsPPI provides opportunity to enhance research design and offers valuable insight towards the needs of healthcare users. Pregnant women want positive health messages, with a focus on what they can/should do, rather than what they should not do. Midwives need to consider their communication with pregnant women, to ensure that their unique relationship is maintained, especially when the topics of diet and weight management are addressed. A well-designed digital intervention could improve access to pregnancy-specific nutrition information; empowering midwives to communicate patient-centred, healthy eating messages with confidence. This has the potential to change dietary and weight management behaviour in pregnant women.

We have completed a 16-channel 340 GHz 3D imaging radar for next-generation airport security screening under the European Union funded CONSORTIS (Concealed Object Stand-Off Real-Time Imaging for Security) project. The radar maps a 1 x 1 x 1 m3 sense volume with ∼1 cm3 voxel resolution at multi-hertz frame rates. The radar has been installed in the CONSORTIS system enclosure and integrated with a passenger control system and command module. The full system will ultimately also incorporate a dual-band passive submillimeter wave imager and automatic anomaly detection software for reliable, ethical detection of concealed objects. A large data collection trial on targets of interest has been conducted to support the development of automatic anomaly detection software. Initial threat detection analysis indicates promising results against aviation-relevant objects including simulant dielectric threat materials.

Background Virtual clinics have been shown to be safe and cost-effective in many specialties, yet barriers exist to their implementation in orthopaedics. Ankle fractures are common and therefore represent a significant clinical workload. The aim of this study was to evaluate the management of radiographically stable Weber B ankle fractures using a standardised treatment protocol in a virtual fracture clinic setting, to assess clinical outcomes, any complications and its cost effectiveness. Methods All patients referred to the VFC with an actual or suspected stable Weber B ankle fracture between September 2013 and September 2015 were identified. The primary outcome measure was successful fracture union. Any complications were noted and a cost analysis comparing the VFC and traditional fracture clinic models was undertaken. Results 314 patients referred with a radiographically stable Weber B ankle fracture were identified. Follow up was complete for 98.4% (309/314) of patients. The union rate was 99.4% (307/309) in patients where follow up was completed. 3.5% (11/309) of patients were underwent acute surgical intervention. Of these patients, 6 were identified as having an unstable injury on weight bearing radiographs at 2 weeks and underwent ORIF, 4 were identified as having an unstable injury on EUA and underwent ORIF and 1 had an EUA with no fixation. 2 patients required ORIF for radiographically confirmed non-union. A cost saving analysis comparing the traditional fracture clinic model and VFC model revealed a saving of £237 per patient (32% reduction) with a VFC model. This represents an estimated saving of almost £40,000 per year for the management of this injury alone in our institution. Conclusion Our study supports the use of a virtual fracture clinic model that is standardised, initiated in ED, and is both safe and cost-effective in the management of radiographically stable Weber B ankle fractures. Level of evidence Level III–Retrospective Cohort Study.

Funding: Part of the research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 312745. The EU FP7 project CONSORTIS (Concealed Object Stand-Off Real-Time Imaging for Security) is developing a demonstrator system for next generation airport security screening which will combine passive and active submillimeter wave imaging sensors. We report on the development of the 340 GHz 3D imaging radar which achieves high volumetric resolution over a wide field of view with high dynamic range and a high frame rate. A sparse array of 16 radar transceivers is coupled with high speed mechanical beam scanning to achieve a field of view of ~ 1 x 1 x 1 m3 and a 10 Hz frame rate. Publisher PDF

C.L.M. acknowledges funding from EPSRC as part of the iMRCDT. The W-band instrument was developed under the U.K. Research Councils Basic Technology Program (grant EP/F039034/1). S.V.D. acknowledges the Research Foundation Flanders (FWO) for financial support (grant G.0687.13). J.E.L. thanks the Royal Society for a University Research Fellowship. Sylvia Dewilde (Biomedical Sciences, University of Antwerp) is thanked for the purification of the Cys46Ser/ Cys55Ser mutant of human neuroglobin (NGB) used in this work. Adelheid Godt’s group is thanked for the synthesis of MSA236. We also thank the Wellcome Trust (grant 099149/Z/12/Z). The research data (and/or materials) supporting this publication can be accessed at http://dx.doi.org/10.17630/b65d05e6-6efa-48b9-a741-5a6322159a4a. The sensitivity of pulsed electron paramagnetic resonance (EPR) measurements on broad-line paramagnetic centers is often limited by the available excitation bandwidth. One way to increase excitation bandwidth is through the use of chirp or composite pulses. However, performance can be limited by cavity or detection bandwidth, which in commercial systems is typically 100-200 MHz. Here we demonstrate in a 94 GHz spectrometer, with > 800 MHz system bandwidth, an increase in signal and modulation depth in a 4-pulse DEER experiment through use of composite rather than rectangular π pulses. We show that this leads to an increase in sensitivity by a factor of 3, in line with theoretical predictions, although gains are more limited in nitroxide-nitroxide DEER measurements. Postprint

In this paper we consider the synthesis of optimal feedback controllers for a stochastically-excited passive electromechanical network, subject to the constraint that in stationarity, the feedback law must be realizable with a regenerative actuation system. Regenerative systems are similar to passive systems but their dynamic constraints are more relaxed, in the sense that they only need to conserve energy in the stationary average sense, rather than at every time instant. In this paper, we examine the design of optimal LQG controllers for passive networks controlled with regenerative actuation. We show that this problem may be posed as a multi-objective LMI problem. We also characterize how close a regeneratively-constrained optimal LQG feedback law is to a passive transfer function. The concepts are demonstrated on a simple example related to vibration suppression.

UNLABELLED Chronic ethanol consumption for 40 weeks in adult rats results in dilation of the extensive smooth endoplasmic reticulum (SER), a major component of the calcium homeostatic system within Purkinje neuron (PN) dendrites. AIMS The aim of the present study was to determine whether chronic ethanol consumption results in alterations of the sarco/endoplasmic reticulum Ca(2+) ATPase pump (SERCA) on the SER membrane of PN dendrites. The density of calreticulin, a calcium chaperone, was also investigated in the PN along with balancing ability. METHODS Ninety 8-month-old rats were exposed to rat chow, the AIN-93 M liquid control or ethanol diets (30/diet) for a duration of 10, 20 or 40 weeks (30/duration). Age changes relative to the rat chow controls were assessed with 3-month-old control rats (n = 10). Balance was assessed prior to euthanasia. Quantitative immunocytochemistry was used to determine the density of SERCA 2b + dendrites and calreticulin + PN soma and nuclei. Molecular layer volumes were also determined. RESULTS Following 40 weeks of ethanol treatment, there were ethanol-induced decreases in SERCA 2b densities within the dendritic arbor and decreased balancing ability on the more difficult round rod balance test. There were no ethanol-induced changes in calreticulin densities. CONCLUSION It can be concluded that ethanol-induced decreases in the SERCA pump accompany SER dilation and contribute to previously reported ethanol-induced dendritic regression in PN. Ethanol-induced changes in balance also occurred. Chronic ethanol consumption does not alter calreticulin expression in PN.

This study addresses the formulation of nonlinear feedback controllers for stochastically excited vibratory energy harvesters. Maximizing the average power generated from such systems requires the transducer current to be regulated using a bi-directional power electronic converter. There are many applications where the implementation of these types of converters is infeasible, due to the higher parasitic losses they must sustain. If instead the transducer current is regulated using a converter capable of single-directional power-flow, then these parasitic losses can be reduced significantly. However, the constraint on the power-flow directionality restricts the domain of feasible feedback laws. The only feasible linear feedback law imposes a static relationship between current and voltage, i.e., a static admittance. In stochastic response, the power generation performance can be enhanced significantly beyond that of the optimal static admittance, using nonlinear feedback. In this paper, a general approach to nonlinear control synthesis for power-flow-constrained energy harvesters is presented, which is analytically guaranteed to outperform the optimal static admittance in stationary stochastic response. Simulation results are presented for a single-degree-of-freedom resonant oscillator with an electromagnetic transducer, as well as for a piezoelectric bimorph cantilever beam.

The second generation AVTIS ground-based millimeter wave instruments designed for monitoring topography of volcanic lava domes are solid state 94 GHz FMCW rastered, real beam radars operating at ranges of up to ~7 km with a range resolution of ~2.5 m. Operating ten times faster than the prototype with reduced power consumption suitable for battery powered portable use as well as installation at a telemetered site under solar power, we examine their performance as tools for monitoring topography over time and report on the operational statistics both as a radar sensor and as a means of generating digital elevation maps. Publisher PDF

Background Adult onset idiopathic isolated focal dystonia presents with a number of phenotypes. Reported prevalence rates vary considerably; well-characterized cohorts are important to our understanding of this disorder. Aim To perform a nationwide epidemiological study of adult onset idiopathic isolated focal dystonia in the Republic of Ireland. Methods Patients with adult onset idiopathic isolated focal dystonia were recruited from multiple sources. Diagnosis was based on assessment by a neurologist with an expertise in movement disorders. When consent was obtained, a number of clinical features including family history were assessed. Results On the prevalence date there were 592 individuals in Ireland with adult onset idiopathic isolated focal dystonia, a point prevalence of 17.8 per 100 000 (95% confidence interval 16.4−19.2). Phenotype numbers were cervical dystonia 410 (69.2%), blepharospasm 102 (17.2%), focal hand dystonia 39 (6.6%), spasmodic dysphonia 18 (3.0%), musician's dystonia 17 (2.9%) and oromandibular dystonia six (1.0%). Sixty-two (16.5%) of 375 consenting index cases had a relative with clinically confirmed adult onset idiopathic isolated focal dystonia (18 multiplex and 24 duplex families). Marked variations in the proportions of patients with tremor, segmental spread, sensory tricks, pain and psychiatric symptoms by phenotype were documented. Conclusions The prevalence of adult onset idiopathic isolated focal dystonia in Ireland is higher than that recorded in many similar service-based epidemiological studies but is still likely to be an underestimate. The low proportion of individuals with blepharospasm may reflect reduced environmental exposure to sunlight in Ireland. This study will serve as a resource for international comparative studies of environmental and genetic factors in the pathogenesis of the disorder.

There is ongoing worldwide interest in finding solutions to enhance the security of civilians at airports, borders and high risk public areas in ways which are safe, ethical and streamlined. One promising approach is to use submillimetre wave 3D imaging radar to detect concealed threats as it offers the advantages of high volumetric resolution (~1 cm3) with practically sized antennas (

This article examines the use of actively controlled electronics to maximize the energy harvested from a stationary stochastic disturbance. In prior work by the authors, it has been shown that when the harvester dynamics are linear and the transmission losses in the electronics are resistive, the optimal feedback controller is the solution to a nonstandard linear-quadratic-Gaussian optimal control problem. This article augments the theory in the following three distinct ways: (a) It illustrates how to use linear matrix inequalities to balance the objective of energy harvesting against other response control objectives (such as minimum requirements on closed-loop damping and maximum levels of voltage response), in the synthesis of the optimal feedback law; (b) it establishes a more realistic characterization of the transmission losses in the actively controlled power electronics used to regulate the extraction of power; and (c) it illustrates how the optimal control theory for resistive loss models can be extended to accommodate the more realistic loss models. The theory is illustrated in the context of a piezoelectric energy harvesting model, and an example is used to illustrate that the theory can be used to simultaneously optimize the feedback law, together with the switching frequency and storage bus voltage of the power electronics.

This article reports on the design and experimental characterization of an electromagnetic transducer for energy harvesting from large structures (e.g., multistory buildings and bridges), for which the power levels can be above 100 W and disturbance frequencies below 1 Hz. The transducer consists of a back-driven ballscrew coupled to a permanent-magnet synchronous machine with power harvesting regulated via control of a four-quadrant power electronic drive. Design considerations between various subsystems are illustrated and recommendations in terms of minimal values are made for each design metric. Developing control algorithms to take full advantage of the unique features of this type of transducer requires a mechanical model that can adequately characterize the device’s intrinsic nonlinear behavior. A new model is proposed that can effectively capture this behavior. Comparison with experimental results verifies that the model is accurate over a wide range of operating conditions. As such, the model can be used to assess the viability of the technology and to correctly design controllers to maximize power generation. To demonstrate the device’s energy harvesting capability, impedance matching theory is used to optimize the power generated from a base-excited tuned mass damper. Both theoretical and experimental investigations are compared and the results are shown to match closely.