Modeling and experiments of O-band transmission over G.654.C optical fiber

We address the potential application of G.654.C optical fiber for O-band transmission in the wavelength range of 1270 nm to 1330 nm. Fiber samples at the extreme upper end of the cable cutoff manufacturing distribution are chosen for modeling and experimentation. Modeling of multipath interference (MPI) generation in bend conditions representative of cable deployment suggests minimal to negligible penalty and transmission experiments at 100 Gb/s and 400 Gb/s with commercial IMDD transceivers demonstrate longer transmission with increased power margin compared to standard G.652 fiber due to lower O-band attenuation and no adverse impacts from MPI.

Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions

OBJECTIVES

This evidence review was conducted to understand how and why workforce development interventions can improve the skills and care standards of support workers in older people's services.

DESIGN

Following recognised realist synthesis principles, the review was completed by (1) development of an initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce; (3) 'testing out' the synthesis findings to refine the programme theories, and establish their practical relevance/potential for implementation through stakeholder interviews; and (4) forming actionable recommendations.

PARTICIPANTS

Stakeholders who represented services, commissioners and older people were involved in workshops in an advisory capacity, and 10 participants were interviewed during the theory refinement process.

RESULTS

Eight context-mechanism-outcome (CMO) configurations were identified which cumulatively comprise a new programme theory about 'what works' to support workforce development in older people's services. The CMOs indicate that the design and delivery of workforce development includes how to make it real to the work of those delivering support to older people; the individual support worker's personal starting points and expectations of the role; how to tap into support workers' motivations; the use of incentivisation; joining things up around workforce development; getting the right mix of people engaged in the design and delivery of workforce development programmes/interventions; taking a planned approach to workforce development, and the ways in which components of interventions reinforce one another, increasing the potential for impacts to embed and spread across organisations.

CONCLUSIONS

It is important to take a tailored approach to the design and delivery of workforce development that is mindful of the needs of older people, support workers, health and social care services and the employing organisations within which workforce development operates. Workforce development interventions need to balance the technical, professional and emotional aspects of care.

TRIAL REGISTRATION NUMBER

CRD42013006283.

An unusual cause of spinal cord compression

Spinal subdural haematoma (SSDH) is a rare, but potentially reversible, cause of spinal cord compression. We describe the case of an 85-year-old lady on long-term low-dose aspirin who presented with features of spinal cord compression. Magnetic resonance imaging (MRI) confirmed a large anterior thoracic SSDH. The aetiology, pathophysiology, clinical features and treatment options are discussed.

Rural-urban differences in the effects on mental well-being of caring for people with stroke or dementia

BACKGROUND

Rural and urban differences in the effects of care-giving are not well documented. This paper reports data on 122 carers for people with stroke or dementia living in rural and urban settings in Wales.

METHOD

Carers completed a postal questionnaire, including the SF-12v2 Health Survey. Definitions of rural and urban were based on the Urban/Rural Indicator from the Office of National Statistics (ONS) All Fields Postcode Directory 2004.

RESULTS

Carers' mean Mental Component Summary (MCS) score (adjusted for age and sex) was one standard deviation below the population mean (-12.03). Male carers living in urban areas reported better mental health than male carers in rural areas (p<0.05) and female carers in both settings (p<0.05). A full model and a parsimonious model were developed, using MCS scores as outcome variables. In the full model sitting service provision in rural and urban locations was linked to better carer mental health, while support from friends and family was linked to better mental health for urban carers only.

CONCLUSION

Our findings indicate the existence of both gender and location differences in carer experiences.

Guidelines for gynecological cancer-an audit of current network documents in England and Wales

The objective of this study was to assess the adequacy of network cancer guidelines paying particular attention to referral criteria, referral routes, tumor diagnosis, staging, and suggested management and care pathways for ovarian and endometrial cancer. Guidelines from 15 regions in England and Wales were analyzed quantitatively and qualitatively as a prospective audit of predefined data items and subsequently agreed management recommendations. Details of unit and center clinicians were included in a minority of documents (2 to 5/15). Multidisciplinary team membership was not usually offered (6/15). Among the least reported data items were histopathology minimum dataset for endometrial cancer and an algorithm for management or summary and clinical symptoms and signs for both cancers. Among the most reported data items were hysteroscopy and ultrasound scanning for endometrial cancer and CA125 and chemotherapy for ovarian cancer. Qualitative analysis revealed differing criteria for the use of endometrial biopsy and radiotherapy in endometrial cancer, for lymphadenectomy and management of recurrent disease in ovarian cancer, and for referral pathways and the use of computed tomography/magnetic resonance (MR) scanning in the assessment of either disease. This study concludes that consideration should be given to the development of national guidelines or templates to ensure consistency of management for gynecological malignancy in England and Wales.

Sir William Jenner (1815-1898) and Queen Victoria

This biographical note outlines the work of Sir William Jenner (1815-1898), court physician 1861-93 and President of the Royal College of Physicians 1881-8. He was the first to distinguish between typhoid and typhus both clinically and pathologically.

The experience of caring for older people with dementia in a rural area: using services

This paper reports findings from the carer component of the Gwynedd Dementia Study. It is based on carer interviews, using quantitative and qualitative data. It confirms earlier findings that carers for people with dementia are typically female and older than other carers, although it notes that caring husbands are amongst the oldest carers. The problems that are most common are those that cause psychological stress to carers. Carers were found to receive both help and appreciation from their families and to perceive neighbours to be helpful if needed. In Gwynedd, as elsewhere, levels of formal service inputs are low, but most of the carers appeared to receive the services they needed. Problems are primarily associated with crisis support and long-term care is accepted reluctantly. It is suggested that community care dementia specialists could play a supporting role for carers.

Carers of older people with dementia: assessment and the Carers Act

The Carers (Recognition and Services) Act 1995 came into force on 1 April 1996. It entitles carers who are providing substantial amounts of care on a regular basis to an assessment of their needs and ability to care. Local authorities are required to take the results of this assessment into account when making decisions about services. This paper reports the key findings of a two-year study, conducted in Wales, that evaluated the process and outcomes of assessments carried out under the auspices of the Carers Act. The findings offer insights to policy makers and practitioners and profile how care managers assess carers' needs. In addition, the paper describes carers' qualitative experiences of the assessment process and the difficulties care managers encounter in translating into practice the policy emphasis on supporting carers. It is suggested that separate carer assessments are not an established feature of care management practice and that care managers lack an explicit framework to direct the assessment of carers' needs.

HIV-AIDS in Nepal: the coming crisis

The number of officially reported cases of HIV infection and of AIDS in Nepal remains low in comparison with numbers in many other Asian countries. But Nepal's open border with India (where HIV infection rates are rapidly rising) and the high level of physical mobility within Nepal and abroad, associated with widespread labor migration and encouraged by the recent development of road transport, means that there is a real danger of a rapid spread of HIV within Nepal. The major means of infection is through heterosexual encounters involving male clients and female sex workers, but other sections of the population are also at risk from infection. Media attention has focused on female sex workers, particularly those who have worked in India, but the issue is far broader than this. Social and economic factors forcing or encouraging young men and women to seek employment away from home underlie the widespread growth of ¿the sex industry¿ and the ¿trafficking¿ of girls and young women. The state's capacity to respond effectively is limited, in part through lack of resources; international agencies are supporting local nongovernmental organizations in a variety of activities designed to ¿educate¿ and to ¿support¿ those at risk; but in the last analysis, it is the local communities from which young men and women migrate and to which they return that are obliged to find ways of coping. Sometimes these communities are supportive of the victims, sometimes not. The spread of HIV-AIDS is not just a ¿health¿ issue, but an issue of economic and social development, of gender relations and of human rights.

Political economy of tobacco control in low-income and middle-income countries: lessons from Thailand and Zimbabwe. Global Analysis Project Team

Crucial to the success of the proposed Framework Convention on Tobacco Control will be an understanding of the political and economic context for tobacco control policies, particularly in low-income and middle-income countries. Policy studies in Thailand and Zimbabwe employed the analytical perspective of political economy and a research strategy that used political mapping, a technique for characterizing and evaluating the political environment surrounding a policy issue, and stakeholder analysis, which seeks to identify key actors and to determine their capacity to shape policy outcomes. These policy studies clearly revealed how tobacco control in low-income and middle-income countries is also being shaped by developments in the global and regional political economy. Hence efforts to strengthen national control policies need to be set within the context of globalization and the international context. Besides the transnational tobacco companies, international tobacco groups and foreign governments, international agencies and nongovernmental organizations are also playing influential roles. It cannot be assumed, therefore, that the tobacco control strategies being implemented in industrialized countries will be just as effective and appropriate when implemented in developing countries. There is an urgent need to expand the number of such tobacco policy studies, particularly in low-income and middle-income countries. Comprehensive guidelines for tobacco policy analysis and research are required to support this process, as is a broader international strategy to coordinate further tobacco policy research studies at country, regional and global levels.

The Conversion of Light Naphtha Into Aromatics by Using Promoted Zeolite Catalysts

Zeolites of the ZSM-5 family are poor for converting liquid paraffins into aromatics, but commercially available H-ZSM-5 can be effectively promoted with zinc or gallium. A gallium-promoted zeolite was used for the conversion of pentane and a natural-gas condensate into aromatic-rich liquid products. Optimum performance was obtained at temperatures of 475�C and weight-hourly space velocity of 1 h-1. The aromatic products were principally benzene, toluene and xylene, with the benzene content increasing with increasing conversion temperature. Operation of the catalyst at high severity (high temperature, low space velocity) produced a liquid product containing over 90% of aromatics. Lower severity produced less aromatics but higher overall liquid yield.

The Crystal Size and Morphology of Silicalite as Influenced by Gel Nucleation Temperature, Alkalinity and Sodium-Chloride Concentration

The influence of sodium chloride, nucleation temperature and alkalinity on crystal size and product morphology of silicalite is described for crystallizations at temperatures of about 170�C. Addition of sodium chloride and increasing alkalinity produce crystals with less intergrowth. Nucleating the gel at 90�C before crystallization significantly reduces crystal size. The intergrowths on the faces of silicalite can be separated and features of the interlocking of separate crystal entities revealed.