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OBJECTIVE: To determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals.DESIGN: This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme.RESULTS: A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive-behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions' interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience.CONCLUSIONS: These findings provide realistic and reliable reporting of outcomes to better support implementation within the 'real world'. Future research such as seeking validation using expert opinions can provide further in depth

This study focuses on the issue of hot mix asphalt patch repairs, the performance of which is greatly reduced by repair edge disintegration. This is caused by low interface temperatures which result in poor repair bonding between fill material and host pavement. Twenty-four pothole repairs, 45 mm in depth, comprising 12 static and 12 dynamic repairs heated for 10 min 15 s and 21 min 49 s, respectively have been investigated. Dynamic heating has been completed using an experimental infrared heater. Temperatures were measured at 11 locations on the repair interfaces during the pouring and compaction of the fill mix. Volumetric of asphalt mixtures were also investigated. The results demonstrated that for static repairs, the lowest maximum temperatures were located at corners and on vertical repair boundaries. It was found that high thermal contact resistance in these interfaces dramatically affect the temperature levels. However, the figures improved in dynamically heated repairs. Comparing dynamically heated repairs of 10 min 15 s and 21 min 49 s with static repairs, showed average corner temperatures increase 10.85–24.45°C and 29.51–36.73°C, respectively, with accompanying increases in vertical interface temperatures 34.97°C and 46.41°C, respectively EPSRC

Efforts to address problems such as mental health, poverty, social exclusion, and chronic disease have often proven resistant to traditional policies or interventions. In this paper, we take up the challenge and present a pioneering new method of analysis in drawing on theoretical and methodological extensions of two prominent approaches, namely, social network analysis and developmental social ecology. Considered in combination, these two seemingly disparate approaches frame a powerful new way of thinking about person-centred care, as well as offer a methodologically more rigorous set of analytical tools. The conceptual model developed from this combination offers to bridge the apparent disconnect between service integration levels and patient needs in such a way as to direct optimal effort to interventions at the individual level and to provide a new innovative approach to the delivery of integrated care. Fil: Woolcott, G.. Southern Cross University; Austria Fil: Keast, R.. Southern Cross University; Austria Fil: Tsasis, P.. University of York; Reino Unido Fil: Lipina, Sebastián Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Chamberlain, D.. La Trobe University; Australia

The present paper investigates the performance and efficacy of four protective surface applied materials; sodium acetate, fluoropolymer, silicone resin and silane when applied to marine structures with different moisture contents. Materials were applied to fully dry and fully saturated concrete along with concrete with 2% and 4% moisture contents. The interaction mechanism of the materials with concrete and their microstructural and morphological assessments were conducted by running SEM, EDX and FTIR analyses to evaluate their performance in the presence of moisture. Also, their efficacy in protecting concrete from water ingress and chloride penetration was evaluated by operating the Initial Surface Absorption Test (ISAT) and Unidirectional salt ponding test respectively. Results demonstrated that moisture content imposes a vital effect on the interaction of the materials with concrete and their adhesion inside the pores, and consequently their efficacy in reducing both, water and chloride penetration.

The purpose of this research is to enhance the performance of Self-compacting Concrete (SCC) to make it a more sustainable alternative to traditional concrete. SCC serves the purpose in harsh environments, therefore, requires protection against de-icing agents and harmful saline environments. This paper reports the results from a laboratory study evaluating the efficacy of two impregnants; pure-silane and water-based silane. Both materials were applied on dry and wet SCC specimens manufactured with high and medium doses of superplasticiser. When treatment is applied on dry samples, a significant reduction in chloride penetration was noticed. However, the impregnants were less effective when applied on specimens subjected to intermediate and long-term exposure to water. In dry conditions, pure-silane performed better than the water-based silane, although they had a similar performance when applied on wet specimens. In addition, increasing the internal moisture content has shown an adverse effect on the efficacy of both materials.

Despite excellent service history, concrete pavement faces accelerated deterioration due to water and chemical ingress through micro cracks and surface voids. Surface protection could be an inexpensive way of enhancing the durability of concrete pavement. This research focuses on evaluating the performance of three surface applied hydrophobic materials with different chemistries; fluoropolymer, silicate resin and sodium acetate crystallising material. Tests consisted of a microscopic study to assess the mechanism of treatment, contact angle and pendulum tests to evaluate the hydrophobicity and frictional properties of treatment respectively. Also, surface absorption and water intake tests were conducted to appraise the resistance of treatment to absorb water. It was found that all three materials are capable of developing a hydrophobic effect in concrete, but with different efficacy in reducing water absorption. The rate of water absorption was minimum for sodium acetate compared to fluoropolymer and silicate resin treatments. Scanning Electron Microscope (SEM) analysis revealed different interaction approaches for the three materials with concrete.

Background: Angiopoietin 1 and 2 regulate angiogenesis and vascular remodelling by interacting with the tyrosine kinase receptor Tie2, and inhibition of angiogenesis has shown promise in the treatment of ovarian cancer. We aimed to assess whether trebananib, a peptibody that inhibits binding of angiopoietin 1 and 2 to Tie2, improved progression-free survival when added to carboplatin and paclitaxel as first-line therapy in advanced epithelial ovarian, primary fallopian tube, or peritoneal cancer in a phase 3 clinical trial. Methods: TRINOVA-3, a multicentre, multinational, phase 3, double-blind study, was done at 206 investigational sites (hospitals and cancer centres)in 14 countries. Eligible patients were aged 18 years or older with biopsy-confirmed International Federation of Gynecology and Obstetrics (FIGO)stage III to IV epithelial ovarian, primary peritoneal, or fallopian tube cancers, and an ECOG performance status of 0 or 1. Eligible patients were randomly assigned (2:1)using a permuted block method (block size of six patients)to receive six cycles of paclitaxel (175 mg/m2)and carboplatin (area under the serum concentration-time curve 5 or 6)every 3 weeks, plus weekly intravenous trebananib 15 mg/kg or placebo. Maintenance therapy with trebananib or placebo continued for up to 18 additional months. The primary endpoint was progression-free survival, as assessed by the investigators, in the intention-to-treat population. Safety analyses included patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov, number NCT01493505, and is complete. Findings: Between Jan 30, 2012, and Feb 25, 2014, 1164 patients were screened and 1015 eligible patients were randomly allocated to treatment (678 to trebananib and 337 to placebo). After a median follow-up of 27·4 months (IQR 17·7–34·2), 626 patients had progression-free survival events (405 [60%]of 678 in the trebananib group and 221 [66%]of 337 in the placebo group). Median progression-free survival did not differ between the trebananib group (15·9 months [15·0–17·6])and the placebo group (15·0 months [12·6–16·1])groups (hazard ratio 0·93 [95% CI 0·79–1·09]; p=0·36). 512 (76%)of 675 patients in the trebananib group and 237 (71%)of 336 in the placebo group had grade 3 or worse treatment-emergent adverse events; of which the most common events were neutropenia (trebananib 238 [35%]vs placebo 126 [38%])anaemia (76 [11%]vs 40 [12%]), and leucopenia (81 [12%]vs 35 [10%]). 269 (40%)patients in the trebananib group and 104 (31%)in the placebo group had serious adverse events. Two fatal adverse events in the trebananib group were considered related to trebananib, paclitaxel, and carboplatin (lung infection and neutropenic colitis); two were considered to be related to paclitaxel and carboplatin (general physical health deterioration and platelet count decreased). No treatment-related fatal adverse events occurred in the placebo group. Interpretation: Trebananib plus carboplatin and paclitaxel did not improve progression-free survival as first-line treatment for advanced ovarian cancer. The combination of trebananib plus carboplatin and paclitaxel did not produce new safety signals. These results show that trebananib in combination with carboplatin and paclitaxel is minimally effective in this patient population. Funding: Amgen. © 2019 Elsevier Ltd

In hot mix asphalt patch repair, inadequate temperature at the interfaces is one of the influencing factors for inferior compaction and poor interface bonding. To enhance repair performance, a precisely controlled infrared pre-heating method for patch repair has been investigated. Asphalt slabs with 45 mm, 75 mm and 100 mm deep pothole excavations were subjected to dynamic heating with infrared heater operating power from 6.6 kW to 7.7 kW. The heater was kept either stationary or moving slowly across the excavations at 130 mm and 230 mm offsets. The tests included evaluating temperature increase throughout the excavations and inside the slab, recording heat power of infrared heater and heating time to avoid burning the asphalt. Irrespective of excavation depth, heating power and offset, the temperature distribution was found non-uniform in the pothole excavations and into the asphalt slab. The temperatures were higher at the faces of the excavation than inside the slab. Dynamic heating for approximately 10 min yielded better heat distribution while minimising the possibility of asphalt overheating and long pre-heating time. It has been concluded that 45 mm and 100 mm deep pothole excavations can be pre-heated with 6.6 kW and stationary heater or 7.5 kW and moving heater at 230 mm and 130 mm offset respectively. 75 mm deep excavation can be pre-heated with 7.1 kW and stationary heater at 230 mm offset.

In hot mix asphalt patch repair, inadequate temperature at the interfaces is one of the influencing factors for inferior compaction and poor interface bonding. To enhance repair performance, a precisely controlled infrared pre-heating method for patch repair has been investigated. Asphalt slabs with 45 mm, 75 mm and 100 mm deep pothole excavations were subjected to dynamic heating with infrared heater operating power from 6.6 kW to 7.7 kW. The heater was kept either stationary or moving slowly across the excavations at 130 mm and 230 mm offsets. The tests included evaluating temperature increase throughout the excavations and inside the slab, recording heat power of infrared heater and heating time to avoid burning the asphalt. Irrespective of excavation depth, heating power and offset, the temperature distribution was found non-uniform in the pothole excavations and into the asphalt slab. The temperatures were higher at the faces of the excavation than inside the slab. Dynamic heating for approximately 10 min yielded better heat distribution while minimising the possibility of asphalt overheating and long pre-heating time. It has been concluded that 45 mm and 100 mm deep pothole excavations can be pre-heated with 6.6 kW and stationary heater or 7.5 kW and moving heater at 230 mm and 130 mm offset respectively. 75 mm deep excavation can be pre-heated with 7.1 kW and stationary heater at 230 mm offset.

The reported research focuses on the problematic lack of durability in executed pothole repairs, much of which arises from inadequate heating of the host pavement during the repair process. A threedimensional finite-element analysis is used to model the temperature distribution in hot mix asphalt (HMA) pothole repairs. Nine pothole repair models are developed including both shallow and deep potholes. Low and high temperatures are applied to a 3D pavement structure and HMA pothole repair mix. Observations are made on (a) the effect of combinations of the existing host pavement temperature regime and that of the HMA placed to fill the pothole, (b) the rate of temperature change during process (a), and (c) the effect of pothole repair depth on temperature change following repair filling. Outcomes demonstrate that boundaries of the formed repair cool substantially faster than the central region and that repair thickness has a substantial influence on this.

This paper reports results from a comprehensive laboratory investigation evaluating the performance of a dual crystalline and a polymeric cementitious protective material for underground concrete structures and structures subjected to water exposure. The amount of pollutants in terms of total dissolved solids (TDS); Potassium Chloride (KCl), 442TM and Sodium Chloride (NaCl) from the coating at the early stage, for the first 21 days after application, was compared against the standard criteria set by the World Health Organization (WHO) for drinking water quality. The results showed that both types of materials are effective in protecting the surface and the rate of pollutants decreases with curing time. The effective curing period for crystalline coating was 120-240 hours, while polymeric coating took shorter period 72 hours. In terms of water absorption, the crystalline coating outperforms its polymer counterpart at all curing times. The pull off test of polymer coatings on the rough and smooth substrates yielded results greater than 1MPa after 120 hours curing, while crystalline coating after 240 hours of curing. Cohesive failure was more common in the crystalline system, whilst adhesive failure was dominant in the polymer system.

Potholes are localized depressions developed in asphalt pavement. Typical pothole repair includes temporary and permanent solutions that are highly affected by detracting factors like thermal segregation, leading to inferior compaction, and poor bonding between old and new layers. To control these factors, a novel prototype Control Pothole Repair System (CPRS), suitably modified for laboratory experimentation, has been developed. The CPRS includes three core features: (a) flexible repair design, (b) multiple, motion controlled radiant heating units that operate within a 443mm by 1.50m working envelope and (c) a Short message service (SMS)/Global positioning system (GPS). The reported study relates the initial development of CPRS and trials with it. Outcomes demonstrate the importance of preheating and strict heating provisions to the boundaries of patch repairs, both affecting the strength and durability of hot asphalt repairs. The laboratory outcomes are also used to effectively calibrate a 3D finite element model of the heating process.

The interaction between homologous DNA molecules in recombination and DNA repair leads to the formation of crossover intermediates known as Holliday junctions. Their enzymatic processing by the RuvABC system in bacteria involves the formation of a complex between RuvA and the Holliday junction. To study the solution structure of this complex, contrast variation by neutron scattering was applied to Mycobacterium leprae RuvA (MleRuvA), a synthetic analogue of a Holliday junction with 16 base-pairs in each arm, and their stable complex. Unbound MleRuvA was octameric in solution, and formed an octameric complex with the DNA junction. The radii of gyration at infinite contrast were determined to be 3.65 nm, 2.74 nm and 4.15 nm for MleRuvA, DNA junction and their complex, respectively, showing that the complex was structurally more extended than MleRuvA. No difference was observed in the presence or absence of Mg2+. The large difference in RG values for the free and complexed protein in 65% 2H2O, where the DNA component is "invisible", showed that a substantial structural change had occurred in complexed MleRuvA. The slopes of the Stuhrmann plots for MleRuvA and the complex were 19 and 15 or less (x10(-5)), respectively, indicating that DNA passed through the centre of the complex. Automated constrained molecular modelling based on the Escherichia coli RuvA crystal structure demonstrated that the scattering curve of octameric MleRuvA in 65% and 100% 2H2O is explained by a face-to-face association of two MleRuvA tetramers stabilised by salt-bridges. The corresponding modelling of the complex in 65% 2H2O showed that the two tetramers are separated by a void space of about 1-2 nm, which can accommodate the width of B-form DNA. Minor conformational changes between unbound and complexed MleRuvA may occur. These observations show that RuvA plays a more complex role in homologous recombination than previously thought.

1. Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2. During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3. The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4. The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5. Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. © 2006 The Authors.

The aim of this thesis was to identify the factors determining reproductive success and breeding density in a rural population of blackbirds occupying contiguous woodland and farmland habitats. Once these factors were identified, an attempt was made to assess the quality of the two habitats in terms of reproductive success. Predation was the major factor affecting reproductive success. There were no significant effects of habitat on predation when habitat was defined as farmland, woodland and woodland edge. When defined in terms of nesting density, high density 'hot-spot' areas had significantly greater nesting cover and lower predation rates than territories in farmland or in the rest of the wood. Parents could adjust their provisioning rates according to chick demand. Consequently chicks in larger broods were not significantly different in weight to chicks in smaller broods. The seasonal change in clutch size is therefore well adapted to conditions for raising nestlings, although there was indirect evidence that female condition may limit clutch size early in the season. The nestlings were fed two main diet types, earthworms and caterpillars, the availability of the former being related to rainfall and temperature and the latter occurring in a seasonal peak. Nestlings fed on predominantly earthworm diets were significantly heavier, thus caterpillars are probably a lower quality prey. Starvation was a minor cause of nestling mortality. There was some evidence that farmland birds were more dependent on earthworms than woodland birds, and consequently only farmland broods showed a significant relationship between weight and rainfall. This conferred no disadvantage to farmland broods, although this may have implications for reproductive success in very dry years. Farmland breeders showed some characteristics of a population in a suboptimal habitat. Breeding density was low on farmland compared with woodland. This in part may have been due to lack of suitable nesting cover. An experiment with artificial nests indicated that predation would be proportionately higher on farmland if nesting density was increased. Year-to-year variations in density across the whole study site paralleled the relative harshness of the preceding winter. Food supplementation prior to the breeding season had no effect on subsequent breeding density or clutch size. It is concluded that farmland is potentially a sub-optimal habitat if subject to different conditions of weather or breeding density than those observed during the three years of this study.

Forty lactating multiparous Yorkshire sows were used to test the hypothesis that reducing dietary CP and supplementing with crystalline amino acids (CAA) increases dietary N utilization for milk production during early and peak lactation. Sows were assigned to 1 of 4 diets: 1) 16.0% CP (as-fed; analyzed contents; HCP); 2) 15.7% CP (MHCP); 3) 14.3% CP (MLCP); 4) 13.2% CP (LCP); diet HCP was formulated using soybean meal and corn as the only Lys sources. The reduced CP diets contained CAA to meet requirements of the limiting AA. Sow and piglet BW were measured on d 1, 3, 7, 14, 18, and 21 of lactation. Nitrogen retention was measured on sows between d 3 and 7 (early) and d 14 and 18 (peak) of lactation. Milk true protein output was calculated from estimated milk yield and analyzed true protein concentration. Sow BW change (overall mean: -4.2 ± 3.37 kg over the 21-d lactation period) and average daily DM intake (overall mean: 4.05 ± 0.18 and 6.12 ± 0.20 kg/d, early and peak lactation, respectively) did not differ between diets. Nitrogen intake decreased as dietary CP concentration decreased (114.3, 106.0, 107.4, and 99.0 ± 5.29 g/d and 169.5, 168.3, 161.2, and 145.1 ± 5.29 g/d for HCP, MHCP, MLCP, and LCP in early and peak lactation, respectively; L: < 0.05). Sow loin eye area loss tended to increase as dietary CP concentration decreased (Linear (): = 0.082). Litter growth rate (LGR) over the 21-d lactation period tended to increase with decreasing dietary CP concentration (L: = 0.084). In early lactation, N retention (N intake- fecal and urinary N) and milk true protein and casein output were not affected by dietary treatment. In early lactation, as dietary CP decreased, N retained as percentage of N intake tended to increase (L: = 0.093) and estimated efficiency of using retained N for milk N output was not influenced by dietary CP concentration. In peak lactation, N retention (122.5, 123.8, 121.2, and 109.0 ± 4.88 g/d for HCP, MHCP, MLCP, and LCP, respectively) decreased (L: < 0.05), N retained as percentage of N absorbed (N intake - fecal N) increased (L: < 0.05), milk casein yield increased ( = 0.051), and estimated efficiency of using retained N for milk N output (44.5, 51.0, 54.9, and 62.9 ± 5.9% for HCP, MHCP, MLCP, and LCP, respectively) increased (L: < 0.05). Feeding lactating diets reduced in CP from 16.0% to 14.3% with CAA inclusion as partial replacement for limiting AA improved N retention and N utilization efficiency for milk protein production in peak lactation, while these effects were less pronounced in early lactation.