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The two beam dumps of the Large Hadron Collider (LHC), made up mostly of low-density graphite, are responsible for absorbing the high-energy particle beams when ejected from the accelerator. In the frame-work of the project to improve the luminosity in the LHC, the beam intensity will be increased by a factor of around two in the coming years. The dominant load on the dump assembly is the energy deposited in the material by the 7 TeV proton beam. Thermomechanical simulations have to be performed to ensure the safe operation of the dump through assessing the integrity in the future. To date, the particle beam contains an average energy of 370 MJ, which is sent to the dump in a sweep movement within around 80 µs. Based on the large dimensions of the dump core and considering the highly dynamic nature of this load, an explicit code like LS-Dyna® was deemed to be best suited for these studies. This paper presents the methodology proposed to model the discrete time structure of the load, caused by the interaction between the particle beam and the dump. Results of the application of this technique, to determine the temperature, stresses and wave propagation on the downstream wall of this device, are described here. In addition to the methodology of the load application, the results of standard quasi-static material tests on the low-density graphite material in the beam dump are presented, to assess the general nature of the material behavior. These experiments will be the basis for a dynamic test campaign to construct a comprehensive material model, as the graphite used in this device has never been fully characterized under such loading conditions.

Background: Limited data suggest that Puerto Ricans experience greater disability than other ethnic groups, but few studies have examined the factors associated with this apparent difference.Methods: We describe the prevalence of functional limitation and disability in a representative sample of Puerto Rican and Dominican elders in Massachusetts, and in a neighborhood comparison group of non-Hispanic whites (NHWs). We then relate disability scores, based on both prevalence and severity of ADL or IADL limitation, with self-reported history of diagnosed health conditions--adjusting for age, sex, body mass index (BMI; weight kg/height m(2)), income, education, living alone, smoking, and alcohol use.Results: Seventy-five percent of Dominican women and 73% of Puerto Rican women reported difficulty with at least one ADL, compared with 64% of NHW women. Puerto Rican men reported significantly more limitation than did NHW or Dominican men. Conditions significantly associated with at least two disability measures among the NHW included smoking, former heavy alcohol use, arthritis, cataract, respiratory disease, and high BMI, but not stroke, diabetes, history of heart attack, or depression. The patterns for Puerto Ricans differed, with the strongest associations between disability and stroke, arthritis, diabetes, and depression, followed by history of heart attack, high BMI, cataract, poverty status, and respiratory disease. Only arthritis and depression were consistently significantly associated with disability among this smaller sample of Dominican elders.Conclusions: Functional limitation and disability are more prevalent among Puerto Ricans and among Dominican women than among neighborhood NHWs in Massachusetts. Greater disability is associated with the presence of chronic health conditions, which differ by ethnic group. Additional research is needed to further define the social and health factors that contribute to these ethnic differences. [ABSTRACT FROM AUTHOR]

Aim: To investigate barriers to healthcare professionals recognizing and managing delirium in hospitalized older people., Design: A mixed-methods systematic review., Prospero Id: CRD42020187932., Data Sources: MEDLINE, EMBASE, PsycINFO and CINAHL were searched (2007 to February 2023)., Review Methods: Included studies focused on healthcare professionals' recognition and management of delirium for patients aged 65 years and over in a hospital ward or emergency department. Enhancing rigour, screening of results was conducted independently by two researchers. Qualitative and quantitative data were tabulated separately and grouped. Data were compared to identify similarities and differences. All studies were quality appraised., Results: 43 studies were included; 24 quantitative, 16 qualitative and three mixed-methods. Data synthesis highlighted synergy between qualitative and quantitative findings. Barriers were reflected in six themes: (1) healthcare professionals' knowledge and understanding; (2) communication; (3) workforce development; (4) interprofessional working; (5) confounders; and (6) organizational constraints., Conclusions: Of significance, for older adults in hospital experiencing delirium, there is variability in whether and how well it is recognized and managed. To prevent adverse outcomes best practice guidance for screening, recognizing, diagnosing and managing delirium in older people needs to be agreed and disseminated widely. Supporting healthcare professionals to care for this patient population using an integrated approach is essential, how to involve and communicate with patients and their family and friends, how to recognize and manage delirium for patients with additional needs, e.g., those living with dementia and/or a learning disability. Hospitals need to have policy and guidance in place for the recognition and management of delirium in older adults presenting to a ward or to an emergency department. An IT infrastructure is needed that integrates assessments and care management plans in patient electronic records and makes them accessible within and across teams in hospital, primary and community care settings., Patient or Public Contribution: There was no patient or public contribution to this systematic review., Implications for the Profession and Patient Care: Healthcare professionals can be better supported to be able to recognize and manage delirium during an acute hospital stay for older adults. This includes maximizing best care for those patients living with dementia, involving families and friends to help understand patients' baseline status and changes and supporting families and friends during this process. Of significance, attention to hospital IT infrastructures is warranted, integrating screening, assessment and care management plans in patients' electronic records and making these accessible to healthcare professionals caring for this patient population across care settings., Impact: What problem did the study address? Delirium is a common condition experienced by older hospitalized patients, but it is consistently under-recognized which has implications for patient and organization outcomes. To help address this, understanding barriers to healthcare professionals recognizing and managing delirium for this patient population is paramount. What were the main findings? Barriers to healthcare professionals recognizing and managing delirium for this patient population were synthesized in six themes: (1) healthcare professionals' knowledge and understanding, (2) communication; (3) workforce development; (4) interprofessional working; (5) confounders; and (6) organizational constraints. Where and on whom will the research have an impact? The findings of this original systematic review can contribute to hospital policy and protocol for the recognition and management of delirium in older patients. The findings can meaningfully contribute to workforce professional development for practitioners caring for older people during an acute hospital stay and for practitioners in primary and community settings involved in the follow-up of patients post hospital discharge. For researchers, the findings indicate several research recommendations including investigating the impact of an education programme for nurses and other healthcare professionals on the recognition and management of the condition and understanding and investigating how best to support delirium-related distress experienced by patients and their families and practitioners., Reporting Method: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021)., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: A skilled, knowledgeable, and compassionate nurse workforce is pivotal to caring well for older people living in care homes. This requires the provision of continuing professional development and career planning for nurses, which are key also for nurse recruitment and retention. Continuing professional development and career planning strategies and interventions should be evidence-driven., Objective: To identify the extent, range and nature of contemporary evidence regarding professional development and career planning for nurses caring for older people living in care homes., Methods: The methodological framework used was the Joanna Briggs Institute guidance for scoping reviews. The PRISMA extension for scoping reviews was used as the reporting framework. Four databases were searched from January 2010 to July 2021. Results were screened independently by two reviewers using eligibility criteria. Full texts and the reference lists of eligible articles were reviewed. Data were extracted for key elements from the 25 articles included., Results: Of the 25 articles, the majority were authored in the United States (n = 10) and UK (n = 8) with the remaining from Australia (n = 3), Canada (n = 3) and the Netherlands (n = 1). Four articles reported on professional development programmes. Three literature reviews addressed challenges for nurse participation in professional development, experiences of care home nurses as clinical leaders and managers, and leadership. Two expert commentaries reported on the challenges related to professional development and career planning for care home nurses. Sixteen empirical studies investigated a range of topics including: competencies, roles, intention to stay and leave, continuing professional development, and leadership. Key emergent factors that support professional development and career planning were as follows: access to structured learning opportunities addressing knowledge and skills specific to nursing frail older adults, a supportive working environment including adequate staffing, study time and flexible working, and integration of leadership development., Conclusions and Implications for Practice: This scoping review has highlighted factors that support and challenge professional development and career planning for nurses working in the care home sector. There remain important gaps in the opportunities for professional development and career planning for care home nurses that warrant attention., (© 2022 The Authors. International Journal of Older People Nursing published by John Wiley & Sons Ltd.)

To study issues of diet and health among Hispanic adults living in the northeastern United States, the authors adapted a version of the National Cancer Institute (NCI)/Block food frequency questionnaire. Foods that contributed to nutrient intake of Puerto Rican adults in the Hispanic Health and Nutrition Examination Survey (HHANES) were ranked to identify items to be added to the food list. Portion sizes were compared across HHANES and the Second National Health and Nutrition Examination Survey (NHANES II) to assess the adequacy of the assumed values. Within line items, frequencies of consumption of individual foods were ranked and these data were used to adjust the weighting factors within the database. To test the revised form, 24-hour recalls were collected from 90 elderly Hispanics and 35 elderly non-Hispanic whites. These data were coded into the original and revised food frequency forms and nutrient intake results were compared with recall results by paired t-test, and by Pearson and intraclass correlations. Added foods include plantains, avocado, mango, cassava, empanadas, and custard. Portion sizes differed significantly between HHANES and NHANES II, and were left open-ended. Estimated mean nutrient intakes and correlations with recall data were lower with the original versus the revised form. The authors conclude that the use in minority populations of food frequency questionnaires developed for the general population is likely to result in biased estimates of intake unless modifications are made in the questionnaires.

A review of studies made in the compost production industry showed the biological agents posing a risk for workers were fungi and thermophile bacteria, gram-negative bacteria and endotoxins, with a prevalent inhalation exposure to airborne contaminated dusts. Medical examinations revealed cases of extrinsic allergic alveolitis due to A. fumigatus, and more frequently irritative and infectious disorders occurring especially in conditions of poor environmental hygiene and macroscopic dust pollution. For the evaluation of the air dispersion of microorganisms, which is high in compost transport and turning operations, at present no exposure limit values are available for biological agents; nevertheless, the concentrations measured were often higher than the limit values proposed for other manufacturing sectors by individual authors and by regulatory agencies in Europe, and were comparable to values observed in other industrial settings for which adverse health effects have been shown. Although the number of studies available are few in number, the results suggest that the hazards posed by microorganisms and the poor environmental hygiene conditions often encountered can undoubtedly be a source of risk for workers, which at present is difficult to establish but significant considering the high airborne concentrations of contaminated dust. Besides technical measures to avoid environmental macroscopic dispersion of dusts, measurement of airborne microbiological contaminants is also recommended. Health surveillance needs to be aimed at identifying subjects with hypersusceptibility to the infectious action of the pathogenetic and/or allergenic agents or with hypersensitivity to the same, and also to periodic control of respiratory organs.

Hyperhomocysteinemia, either fasting or after methionine loading, may contribute to the increased incidence of cardiovascular disease events experienced by renal transplant recipients. Limited data are available on fasting homocysteine (Hcy) levels, and none on postmethionine-loading Hcy levels, in these patients. We assessed the prevalence and potential determinants of fasting and postmethionine-loading hyperhomocysteinemia in 29 stable renal transplant recipients and 58 age- and sex-matched, population-based controls free of renal disease with serum creatinine levels of 1.5 mg/dL or less. Total (t) plasma Hcy was determined fasting and 2 hours after methionine loading, along with fasting determinations of the B-vitamin cofactors/substrates for Hcy metabolism, ie, pyridoxal 5'-phosphate, B-12, and folate and serum creatinine. Geometric mean fasting (18.1 versus 9.8 microM, P < .001) and postmethionine-loading increase (22.0 versus 15.2, P = .001) in tHcy levels were significantly greater in the renal transplant recipients, as were the prevalence odds (with 95% confidence intervals) for fasting [14.8 (3.4-64.7)], postmethionine loading [6.9 (1.5-32.8)], combined fasting and postmethionine-loading [18.0 (2.3-142.1)] hyperhomocysteinemia, and inadequate circulating folate [4.2 (1.1-16.5)] or pyridoxal 5'-phosphate [3.2 (0.9-11.0) status. Correlation analyses suggested important potential relationships between creatinine and both fasting (+0.64, P < .001) and postmethionine-load increase (+0.38, P = .045) in tHcy, folate and fasting (-0.41, P = .025) tHcy, and pyridoxal 5'-phosphate and postmethionine-loading increase (-0.33, P = .091) in tHcy. We conclude that there is an excess prevalence of fasting and postmethionine-loading hyperhomocysteinemia in stable renal transplant recipients. Renal function is related to both fasting and postmethionine loading-hyperhomocysteinemia, inadequate folate status is associated with fasting hyperhomocysteinemia, and inadequate vitamin B-6 status may be related to postmethionine-loading hyperhomocysteinemia in this patient population.

Objectives: The choice between sulfasalazine and 5-aminosalicylate (5-ASA) drugs in the management of patients with ulcerative colitis often depends on idiosyncrasies of drug tolerance and control of the disease in individual patients. We sought to evaluate whether there were population differences in the effect of 5-ASA and sulfasalazine on the occurrence of clinically recognized adverse events. We also attempted to determine whether there were differences in the use of concomitant steroids and in the rates of hospitalization., Methods: We reviewed a large computerized database drawn from general practices in the United Kingdom. There we found records of 2894 patients in whom general practitioners had diagnosed ulcerative colitis, and who were receiving ongoing medical therapy specific to ulcerative colitis. The period of data availability ran from the beginning of 1990 to the latter part of 1993. The average duration of observation was 2.1 yr per patient. Patient histories were categorized into distinct periods according to the dose of 5-ASAs and sulfasalazine, steroids, and immunosuppressants, and were further separated according to the activity of ulcerative colitis. Within these categories, we examined the initiation and discontinuation of steroids, incidence of new hospitalizations for ulcerative colitis, and clinical mention of adverse events., Results: New clinical mentions of hepatic, pancreatic, renal, and hematological events other than anemia were similar among the 5-ASAs and were very infrequent overall. Hospitalizations for ulcerative colitis occurred with similar frequency (about 15 hospitalizations per 100 patients per year) among users of those drugs. Patients receiving sulfasalazine had lower rates of initiation of prednisolone than did patients receiving 5-ASA, but sulfasalazine was used proportionately less often in patients who had been recently hospitalized, and it may be that sulfasalazine patients were somewhat less sick, overall, than were 5-ASA-using patients. The choice of drug did not affect discontinuation rates for prednisolone among established users., Conclusions: In the United Kingdom, during the period of this study, serious adverse reactions to drugs were not an important aspect of the management of patients with ulcerative colitis. Renal and pancreatic complications of sulfasalazine and 5-ASA therapy were extremely rare. Sulfasalazine and 5-ASA drugs have similar steroid-sparing properties. Disease-specific hospitalizations are approximately 100 times more common in ulcerative colitis patients than are serious adverse drug effects. Considerations of drug efficacy should therefore dominate the choice between therapeutic agents.