A picture of health: determining the core population served by an urban NHS hospital trust and understanding the key health needs

Background NHS hospitals do not have clearly defined geographic populations to whom they provide care, with patients able to attend any hospital. Identifying a core population for a hospital trust, particularly those in urban areas where there are multiple providers and high population churn, is essential to understanding local key health needs especially given the move to integrated care systems. This can enable effective planning and delivery of preventive interventions and community engagement, rather than simply treating those presenting to services. In this article we describe a practical method for identifying a hospital’s catchment population based on where potential patients are most likely to reside, and describe that population’s size, demographic and social profile, and the key health needs. Methods A 30% proportional flow method was used to identify a catchment population using an acute hospital trust in West London as an example. Records of all hospital attendances between 1st April 2017 and 31st March 2018 were analysed using Hospital Episode Statistics. Any Lower Layer Super Output Areas where 30% or more of residents who attended any hospital for care did so at the example trust were assigned to the catchment area. Publicly available local and national datasets were then applied to identify and describe the population’s key health needs. Results A catchment comprising 617,709 people, of an equal gender-split (50.4% male) and predominantly working age (15 to 64 years) population was identified. Thirty nine point six percent of residents identified as being from Black and Minority Ethnic (BAME) groups, a similar proportion that reported being born abroad, with over 85 languages spoken. Health indicators were estimated, including: a healthy life expectancy difference of over twenty years; bowel cancer screening coverage of 48.8%; chlamydia diagnosis rates of 2,136 per 100,000; prevalence of visible dental decay among five-year-olds of 27.9%. Conclusions We define a blueprint by which a catchment can be defined for a hospital trust and demonstrate the value a hospital-view of the local population could provide in understanding local health needs and enabling population-level health improvement interventions. While an individual approach allows tailoring to local context and need, there could be an efficiency saving were such public health information made routinely and regularly available for every NHS hospital.

Signature laminar distributions of pathology in frontotemporal lobar degeneration

Frontotemporal lobar degeneration (FTLD) with either tau (FTLD-tau) or TDP-43 (FTLD-TDP) inclusions are distinct proteinopathies that frequently cause similar frontotemporal dementia (FTD) clinical syndromes. FTD syndromes often display macroscopic signatures of neurodegeneration at the level of regions and networks, but it is unclear if subregional laminar pathology display patterns unique to proteinopathy or clinical syndrome. We hypothesized that FTLD-tau and FTLD-TDP accumulate pathology in relatively distinct cortical layers independent of clinical syndrome, with greater involvement of lower layers in FTLD-tau. The current study examined 170 patients with either FTLD-tau (n = 73) or FTLD-TDP (n = 97) spanning dementia and motor phenotypes in the FTD spectrum. We digitally measured the percent area occupied by tau and TDP-43 pathology in upper layers (I–III), lower layers (IV–VI), and juxtacortical white matter (WM) from isocortical regions in both hemispheres where available. Linear mixed-effects models compared ratios of upper to lower layer pathology between FTLD groups and investigated relationships with regions, WM pathology, and global cognitive impairment while adjusting for demographics. We found lower ratios of layer pathology in FTLD-tau and higher ratios of layer pathology in FTLD-TDP, reflecting lower layer-predominant tau pathology and upper layer-predominant TDP-43 pathology, respectively (p < 0.001). FTLD-tau displayed lower ratios of layer pathology related to greater WM tau pathology (p = 0.002) and to earlier involved/severe pathology regions (p = 0.007). In contrast, FTLD-TDP displayed higher ratios of layer pathology not related to either WM pathology or regional severity. Greater cognitive impairment was associated with higher ratios of layer pathology in FTLD-tau (p = 0.018), but was not related to ratios of layer pathology in FTLD-TDP. Lower layer-predominant tau pathology and upper layer-predominant TDP-43 pathology are proteinopathy-specific, regardless of clinical syndromes or regional networks that define these syndromes. Thus, patterns of laminar change may provide a useful anatomical framework for investigating how degeneration of select cells and corresponding laminar circuits influence large-scale networks and clinical symptomology in FTLD.

Analysis of Hydraulic Characteristics and Treatment Efficiency by Filter Media Composition During Backwashing of Filtration-Type Non-Point Pollution Facilities

In this study, the hydraulic characteristics and pollutant treatment efficiency during backwashing were analyzed through laboratory-scale hydraulic model experiments for filtration-type non-point pollution reduction facilities. The filter media used in the experiment were analyzed by calculating the change in head loss for single or complex arrangements of wood chips (WC), sand (SA), and bottom ash (BA). These are commonly used to improve the adsorption mechanism in non-point pollution reduction facilities, from which the pollutant treatment efficiency was derived. The SS treatment efficiency experiments for each filter media layer were conducted with SA+WC (WC 0.3 m in the upper layer, SA 0.3 m in the lower layer) and SA+BA (SA 0.3 m in the upper layer, BA 0.3 m in the lower layer), and the removal efficiency was greater than 80%, indicating good efficiency. In the case of SA+BA, analysis showed a high removal efficiency of 87.4% at a linear velocity of 20 m/hr.

DESIGN AND PARAMETER OPTIMIZATION OF LAYERED FERTILIZATION OPENER FOR WHEAT, BASED ON EDEM

Applying different types of fertilizers to different depths of soil according to demand is advantageous in that it can optimize the distribution of nutrients in arable soil, adjust the nutrient supply of each growth stage of wheat, and increase grain yield. In the study, a layered fertilization opener that could realize the layered fertilization was developed. The interaction model between the opener, fertilizer and soil was established using EDEM simulation software. A response surface analysis was used to determine the optimal parameters of the opener. Specifically, the horizontal distance between the fertilizer drop openings was 140 mm, the machine speed was 1.05 m/s, and the angle of the opener was 37°. Furthermore, field experiments demonstrated that the average depth of upper layer was 8.39 cm, the average depth of middle layer was 16.465 cm, the average depth of lower layer was 24.025 cm, the average spacing of upper layer was 8.075 cm, and the average spacing of lower layer was 7.6 cm. The corresponding findings demonstrated that the layering effect of the opener met the requirements of the fertilization standard.

Torque allocation strategy for four in-wheel-motor drive electric vehicle based on layered control

The differential torque of four in-wheel-motor drive electric automotive will affect vehicle stability, and applications of the differential driven assisting steering (DDAS) will be limited consequentially. To solve this problem, stability analysis and control system design is essential, therefore a DDAS stability control system is designed based on the layered control of yaw moment. Correlation functions are used to reflect the shifts of vehicle characteristic state between stable and unstable states, and help to determine the control weight of each subsystem in the lower-layer controller. In the lower-layer controller, the strategy of direct steering-wheel torque control is used to build a DDAS controller. Under different vehicle moving states, differential driving torque and yaw moment vary with the change of the control weights; and according to the theory of quadratic programming, optimal allocation of four-wheel driving torques will be made according to the total driving torque. The effectiveness of the proposed control system is verified by numerical simulation and hardware-in-the-loop experiment. The results show that the proposed control method can improve vehicle stability and ensure driving safety.

Stratification effects on shoaling internal solitary waves

This combined numerical/laboratory study investigates the effect of stratification form on the shoaling characteristics of internal solitary waves propagating over a smooth, linear topographic slope. Three stratification types are investigated, namely (i) thin tanh (homogeneous upper and lower layers separated by a thin pycnocline), (ii) surface stratification (linearly stratified layer overlaying a homogeneous lower layer) and (iii) broad tanh (continuous density gradient throughout the water column). It is found that the form of stratification affects the breaking type associated with the shoaling wave. In the thin tanh stratification, good agreement is seen with past studies. Waves over the shallowest slopes undergo fission. Over steeper slopes, the breaking type changes from surging, through collapsing to plunging with increasing wave steepness $A_w/L_w$ for a given topographic slope, where $A_w$ and $L_w$ are incident wave amplitude and wavelength, respectively. In the surface stratification regime, the breaking classification differs from the thin tanh stratification. Plunging dynamics is inhibited by the density gradient throughout the upper layer, instead collapsing-type breakers form for the equivalent location in parameter space in the thin tanh stratification. In the broad tanh profile regime, plunging dynamics is likewise inhibited and the near-bottom density gradient prevents the collapsing dynamics. Instead, all waves either fission or form surging breakers. As wave steepness in the broad tanh stratification increases, the bolus formed by surging exhibits evidence of Kelvin–Helmholtz instabilities on its upper boundary. In both two- and three-dimensional simulations, billow size grows with increasing wave steepness, dynamics not previously observed in the literature.

Design and Fabrication of Pneumatically Actuated Valveless Pumps

In this study, a valveless pump was successfully designed and fabricated for the purpose of medium transportation. Different from traditional pumps, the newly designed pump utilizes an actuated or a deflected membrane, and it serves as the function of a check valve at the same time. For achieving the valveless property, an inlet or outlet port positioned in an upper- or lower-layer thin membrane was designed to be connected to an entrance or exit channel. Theoretical analysis and numerical simulation were conducted simultaneously to investigate the large deformation characteristics of the membranes and to determine the proper location of the inlet or outlet port on the proposed pump. Then, the valveless pump was fabricated on the basis of the proposed design. In the experiment, the maximum flow rate of the proposed pump exceeded 12.47 mL/min at a driving frequency of 5.0 Hz and driving pressure of 68.95 kPa.

An Archaeological Study of Early Farming Settlements on Iresi Hills

Recent Investigation of an archaeological site in southwest Nigeria during the Late Stone Age revealed additional information about the cultural development of the area. On Iresi Hills two rock shelters (Ajaye and Cherubim & Seraphim) were investigated in two seasons from 2017 to 2018 during which pottery, ground stone axes and microlithics were excavated. Although there is no clear break in the stratigraphy, the findings show clear demarcation between two cultural layers. The upper layer contains pottery, microlithics and ground stone axes, and ochre while the lower layer is characterized by microlithics only. The site presented a date of about Cal 5653 BP which coincides with a short dry period in the area. Tis paper reports the occupation in Iresi, in southwest Nigeria with a view to fill the gap in the chronology and to interrogate the evidence for Late Stone Age in terms of the culture that existed in between 12000YBP of Iwo Eleru and 2000YBP of Itaakpa and the influence of a change in environment of southwest Nigeria and West Africa in general.

Comparative Study of Structures and Properties of Detonation Coatings with α-Al2O3 and γ-Al2O3 Main Phases

This study is aimed at obtaining a coating of aluminum oxide containing α-Al2O3 as the main phase by detonation spraying, as well as a comparative study of the structural, tribological and mechanical properties of coatings with the main phases of α-Al2O3 and γ-Al2O3. It was experimentally revealed for the first time that the use of propane as a combustible gas and the optimization of the technological regime of detonation spraying leads to the formation of an aluminum oxide coating containing α-Al2O3 as the main phase. Tribological tests have shown that the coating with the main phase of α-Al2O3 has a low value of wear volume and coefficient of friction in comparison with the coating with the main phase of γ-Al2O3. It was also determined that the microhardness of the coating with the main phase of α-Al2O3 is 25% higher than that of the coatings with the main phase of γ-Al2O3. Erosion resistance tests have shown (evaluated by weight loss) that the coating with α-Al2O3 phase is erosion-resistant compared to the coating with γ-Al2O3 (seen by erosion craters). However, the coating with the main phase of γ-Al2O3 has a high value of adhesion strength, which is 2 times higher than that of the coating with the main phase of α-Al2O3. As the destruction of coatings by the primary phase, α-Al2O3 began at low loads than the coating with the main phase γ-Al2O3. The results obtained provide the prerequisites for the creation of wear-resistant, hard and durable layered coatings, in which the lower layer has the main phase of γ-Al2O3, and the upper layer has the main phase of α-Al2O3.

Flexible Vibrotactile Actuator Based on Dielectric Elastomer for Smart Handheld Devices

This paper presents an electroactive and soft vibrotactile actuator based on a dielectric elastomer. The vibrotactile actuator is composed of an upper layer, an adhesive tape layer, a dielectric layer with bumps, and a lower layer. When a voltage is applied to the actuator, an electrostatic force created between the upper and lower layers pulls the upper layer down, compressing the dielectric layer. As soon as the applied voltage is released, the upper layer is quickly restored to its initial state by the elastic force of the compressed dielectric elastomer. Because two forces contribute to the actuation at the same time, the created vibration is sufficiently strong to stimulate human mechanoreceptors. When the applied voltage is removed, the upper layer and dielectric elastomer return to their initial shapes. We conducted experiments to determine the best weight ratio of polydimethylsiloxane (PDMS) and Ecoflex, and to quantitatively investigate the haptic performance of the proposed vibrotactile actuator. The experiments clearly show that the plasticized vibrotactile actuator can create a variety of haptic sensations over a wide frequency range.