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Chronic non-cancer pain (CNCP) involves one-third of the US population, and prescription opioids contribute to the opioid epidemic. The Centers for Disease Control and Prevention emphasizes maximizing non-opioid treatment, but many rural populations cannot access alternative therapies. Clinical and Translational Science Award hubs across four rural states performed a multi-site, single-arm intervention feasibility study testing methods and procedures of implementing a behavioral intervention, acceptance and commitment therapy, in primary care CNCP patients on chronic opioids. Using the CONSORT extension for feasibility studies, we describe lessons learned in recruiting/retaining participants, intervention implementation, data measurement, and multi-site procedures. Results inform a future definitive trial and potentially others conducting rural trials.
To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15–1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, −25%; IQR, −20% to −29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%–105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, −15%; IQR, −14% to −21%) and decreased the SIR at all hospitals (median, −8%; IQR, −4% to −11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.
This trial compared weight loss outcomes over 14 weeks in women showing low- or high-satiety responsiveness (low- or high-satiety phenotype (LSP, HSP)) measured by a standardised protocol. Food preferences and energy intake (EI) after low and high energy-density (LED, HED) meals were also assessed. Ninety-six women (n 52 analysed; 41·24 (SD 12·54) years; 34·02 (sd 3·58) kg/m2) engaged in one of two weight loss programmes underwent LED and HED laboratory test days during weeks 3 and 12. Preferences for LED and HED food (Leeds Food Preference Questionnaire) and ad libitum evening meal and snack EI were assessed in response to equienergetic LED and HED breakfasts and lunches. Weekly questionnaires assessed control over eating and ease of adherence to the programme. Satiety quotients based on subjective fullness ratings post LED and HED breakfasts determined LSP (n 26) and HSP (n 26) by tertile splits. Results showed that the LSP lost less weight and had smaller reductions in waist circumference compared with HSP. The LSP showed greater preferences for HED foods, and under HED conditions, consumed more snacks (kJ) compared with HSP. Snack EI did not differ under LED conditions. LSP reported less control over eating and reported more difficulty with programme adherence. In conclusion, low-satiety responsiveness is detrimental for weight loss. LED meals can improve self-regulation of EI in the LSP, which may be beneficial for longer-term weight control.
Background: Focal cortical dysplasias (FCDs) are congenital structural abnormalities of the brain, and represent the most common cause of medication-resistant focal epilepsy in children and adults. Recent studies have shown that somatic mutations (i.e. mutations arising in the embryo) in mTOR pathway genes underlie some FCD cases. Specific therapies targeting the mTOR pathway are available. However, testing for somatic mTOR pathway mutations in FCD tissue is not performed on a clinical basis, and the contribution of such mutations to the pathogenesis of FCD remains unknown. Aim: To investigate the feasibility of screening for somatic mutations in resected FCD tissue and determine the proportion and spatial distribution of FCDs which are due to low-level somatic mTOR pathway mutations. Methods: We performed ultra-deep sequencing of 13 mTOR pathway genes using a custom HaloPlexHS target enrichment kit (Agilent Technologies) in 16 resected histologically-confirmed FCD specimens. Results: We identified causal variants in 62.5% (10/16) of patients at an alternate allele frequency of 0.75–33.7%. The spatial mutation frequency correlated with the FCD lesion’s size and severity. Conclusions: Screening FCD tissue using a custom panel results in a high yield, and should be considered clinically given the important potential implications regarding surgical resection, medical management and genetic counselling.
Oceanic anoxic events (OAEs) are contemporaneous with 11 of the 18 largest Phanerozoic extinction events, but the magnitude and selectivity of their paleoecological impact remains disputed. OAEs are associated with abrupt, rapid warming and increased CO2 flux to the atmosphere; thus, insights from this study may clarify the impact of current anthropogenic climate change on the biosphere. We investigated the influence of the Late Cretaceous Bonarelli event (OAE2; Cenomanian/Turonian stage boundary; ~94 Ma) on generic- and species-level molluscan diversity, extinction rates, and ecological turnover. Cenomanian/Turonian results were compared with changes across all Cretaceous stage boundaries, some of which are coincident with less severe OAEs. We found increased generic turnover, but not species-level turnover, associated with several Cretaceous OAEs. The absence of a species-level pattern may reflect species occurrence data that are too temporally coarse to robustly detect patterns. Five hypotheses of ecological selectivity relating anoxia to survivorship were tested across stage boundaries with respect to faunality, mobility, and diet using generalized linear models. Interestingly, benthic taxa were consistently selected against throughout the Cretaceous regardless of the presence or absence of OAEs. These results suggest that: (1) the Cenomanian/Turonian boundary (OAE2) was associated with a decline in molluscan diversity and increase in extinction rate that were significantly more severe than Cretaceous background levels; and (2) no differential ecological selectivity was associated with OAE-related diversity declines among the variables tested here.
We assessed whether paternal demographic, anthropometric and clinical factors influence the risk of an infant being born large-for-gestational-age (LGA). We examined the data on 3659 fathers of term offspring (including 662 LGA infants) born to primiparous women from Screening for Pregnancy Endpoints (SCOPE). LGA was defined as birth weight >90th centile as per INTERGROWTH 21st standards, with reference group being infants ⩽90th centile. Associations between paternal factors and likelihood of an LGA infant were examined using univariable and multivariable models. Men who fathered LGA babies were 180 g heavier at birth (P<0.001) and were more likely to have been born macrosomic (P<0.001) than those whose infants were not LGA. Fathers of LGA infants were 2.1 cm taller (P<0.001), 2.8 kg heavier (P<0.001) and had similar body mass index (BMI). In multivariable models, increasing paternal birth weight and height were independently associated with greater odds of having an LGA infant, irrespective of maternal factors. One unit increase in paternal BMI was associated with 2.9% greater odds of having an LGA boy but not girl; however, this association disappeared after adjustment for maternal BMI. There were no associations between paternal demographic factors or clinical history and infant LGA. In conclusion, fathers who were heavier at birth and were taller were more likely to have an LGA infant, but maternal BMI had a dominant influence on LGA.
Ammonia was searched in the direction of 46 sources placed in the southern hemisphere where H2CO or H2O was detected previously. Observations were carried out at Itapetinga Radio Observatory, Atibaia, Brazil using a 13.7 m paraboloid. The receiver used for these observations had a K-band ruby travelling wave maser as a preamplifier and the system temperature ranged from 250 to 300K. All sources were observed at least twice, each observation lasting for 30 minutes. The filter bank used consisted of 47 contiguous channels with 100 kHz bandwidth. Results are presented on Table 1 — Positive results and Table 2 — Negative results.
There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.
Thermal rectification in nanostructured materials is an active topic of research and development. Here it is suggested that porous semiconductor materials can offer an unmatched tailoring of its structural properties, resulting in both the ability to study the effects of nanoscale morphology on thermal rectification phenomenon, and the perspective to achieve large thermal rectification over a wide temperature range in combination with other beneficial properties, such as a wide tunability of thermal conductivity, or optical transparency of the thermally rectifying structure. In this contribution we are presenting the first to our knowledge experimental demonstration of thermal rectification in mesoporous silicon. The influence of pore morphology controlled via Si substrate crystallographic orientation and etching conditions on thermal rectification are studied. The effect of oxidation of the porous material is presented as well. Experimental results are further compared with several recently published theoretical predictions of thermal rectification in similar structures.
We present results of modeling and experimental characterization of thermoelectric (TE) materials built on new fabrication principles, involving the coating of three-dimensionally structured quantum well super-lattice substrates with PbTe/PbSe. A new system for wafer-scale electrochemical deposition of such structures was specifically developed and will be described in this paper. Scanning electron microscopy (SEM) was used to measure film thickness and electron diffraction spectroscopy (EDS) was used to determine film material concentration. By adjusting deposition parameters, we were able to build stoichiometric PbSe, PbTe and stacked PbSe/PbTe super-lattice films on planar and pre-structured surfaces. The films were thermoelectrically modelled using COMSOL and then characterized using an infrared Seebeck effect measurement system which measured surface heating of the film while measuring the voltage associated with the temperature gradient. We report advances in the design and fabrication of TE materials which improve cost-effectiveness and TE efficiency.
Many modern paleobiological analyses are conducted at the generic level, a practice predicated on the validity of genera as meaningful proxies for species. Uncritical application of genera in such analyses, however, has led—perhaps inadvertently—to the unjustified reification of genera in an evolutionary context. While the utility of genera as proxies for species in evolutionary studies should be evaluated as an empirical issue, in practice it is increasingly assumed (rather than demonstrated) that genera are suitable proxies for species. This is problematic on both ontological and epistemological grounds. Genera are arbitrarily circumscribed, non-equivalent, often paraphyletic, and sometimes polyphyletic collections of species. They are useful tools for communication but have no theoretical or biological reality of their own and, whether monophyletic or not, cannot themselves operate in the evolutionary process. Attributes considered important for understanding macroevolution—e.g., geographic ranges, niche breadths, and taxon durations—are frequently variable among species within genera and will be inflated at the generic level, especially in species-rich genera. Consequently, the meaning(s) of results attained at the generic level may not “trickle down” in any obvious way that elucidates our understanding of evolution at the species level. Ideally, then, evolutionary studies that are actually about species should be pursued using species-level data rather than proxy data tabulated using genera. Where genera are used, greater critical attention should be focused on the degree to which attributes tabulated at the generic level reflect biological properties and processes at the species level.
This study aimed to replicate a previous study which showed that endogenous opioid release, following an oral dose of amphetamine, can be detected in the living human brain using [11C]carfentanil positron emission tomography (PET) imaging. Nine healthy volunteers underwent two [11C]carfentanil PET scans, one before and one 3 h following oral amphetamine administration (0.5 mg/kg). Regional changes in [11C]carfentanil BPND from pre- to post-amphetamine were assessed. The amphetamine challenge led to significant reductions in [11C]carfentanil BPND in the putamen, thalamus, frontal lobe, nucleus accumbens, anterior cingulate, cerebellum and insula cortices, replicating our earlier findings. None of the participants experienced significant euphoria/‘high’, supporting the use of oral amphetamine to characterize in vivo endogenous opioid release following a pharmacological challenge. [11C]carfentanil PET is able to detect changes in binding following an oral amphetamine challenge that reflects endogenous opioid release and is suitable to characterize the opioid system in neuropsychiatric disorders.
The UK was one of few European countries to document a substantial wave of pandemic (H1N1) 2009 influenza in summer 2009. The First Few Hundred (FF100) project ran from April–June 2009 gathering information on early laboratory-confirmed cases across the UK. In total, 392 confirmed cases were followed up. Children were predominantly affected (median age 15 years, IQR 10–27). Symptoms were mild and similar to seasonal influenza, with the exception of diarrhoea, which was reported by 27%. Eleven per cent of all cases had an underlying medical condition, similar to the general population. The majority (92%) were treated with antiviral drugs with 12% reporting adverse effects, mainly nausea and other gastrointestinal complaints. Duration of illness was significantly shorter when antivirals were given within 48 h of onset (median 5 vs. 9 days, P=0·01). No patients died, although 14 were hospitalized, of whom three required mechanical ventilation. The FF100 identified key clinical and epidemiological characteristics of infection with this novel virus in near real-time.
Bok globules, optically opaque small dark clouds, are classical examples of isolated star formation. However, the collapse mechanism for these cold, dense clouds of gas and dust is not well understood. Observations of Bok globules include some which appear to be starless while others harbor single stars, binaries and even small groups of forming stars. One example of a Bok globule forming a group of stars is CB 34, observed with both the IRAC and MIPS instruments as part of the Spitzer Young Cluster Survey. Based on initial analysis of 1-8 μm photometry from IRAC and the Two Micron All Sky Survey (2MASS), we identified 9 Class 0/I and 14 Class II young stellar objects within the small, 4.5′ × 4.5′ region encompassing CB 34. This unusually high number of protostars compared with Class II sources is intriguing because it implies a high rate of star formation. Therefore we have begun a larger study of this region in order to determine why and how CB 34 started forming stars at such a high rate. Is CB 34 embedded within a larger HII region which may have triggered its collapse or does it appear to have collapsed in isolation from outside influences?
We present initial results from a survey of the Orion A and B molecular clouds made with the InfraRed Array Camera (IRAC) onboard the Spitzer Space Telescope. This survey encompasses a total of 5.6 square degrees with the sensitivity to detect objects below the hydrogen burning limit at an age of 1 Myr. These observations cover a number of known star forming regions, from the massive star forming clusters in the Orion Nebula and NGC 2024, to small groups of low mass stars in the L1641. We combine the IRAC photometry with photometry from the 2MASS point source catalog and use the resulting seven band data to identify stars with infrared excesses due to dusty disks and envelopes. Using the presence of an infrared excess as an indicator of youth, we show the distribution of young stars and protostars in the two molecular clouds. We find that roughly half of the stars are found in dense clusters surrounding the two regions of recent massive star formation in the Orion clouds, NGC 2024 and the Orion Nebula.
MOCVD templates grown on sapphire with a Gallium Treatment Step (GTS) instead of a low temperature AlN or GaN nucleation layer are used for HVPE growth. Four templates are used with varying times of MOCVD buffer layer growth. 25 μm GaN is grown with HVPE on these templates. The HVPE layers are studied with optical microscopy and X-ray diffraction (XRD). The results show that the thickness of the buffer layer is not important for the quality of the HVPE grown layer once sufficient nucleation sites for HVPE growth are present. The excellent quality of the templates with GTS for HVPE growth is shown with a 100 μm thick HVPE layer on a 2” template. No cracks in either sapphire or GaN are visible.
We have studied the structural and optical properties of InAlN alloys with compositions nearly lattice-matched to GaN. Scanning electron microscopy measurements reveals a good overall surface quality, with some defect structures distributed across the surface whose density increases with the InN concentration. On the other hand, Raman scattering experiments show three peaks in the frequency range between 500 and 900 cm-1, which have been assigned to InN-like and AlN-like E2 modes and A1(LO) mode of the InAlN. These results agree with theoretical calculations previously reported where two-mode and one-mode behavior was predicted for the E and A(LO) modes, respectively. Photoluminescence and photoluminescence excitation allowed us to determine the emission and absorption energies of the InAlN epilayers. Both energies display a redshift as the InN fraction increases. We find a roughly linear increase of the Stokes shift with InN fraction, with Stokes shift values of ≈0.5 eV in the composition range close to the lattice-matched condition.
Active nitrogen species produced by an Oxford Applied Research HD-25 plasma source have been monitored by optical emission spectroscopy and quadrapole mass spectroscopy. Both techniques confirmed that at higher RF powers and lower flow rates the efficiency of atomic nitrogen production increased; emission spectroscopy confirmed that this was at the expense of active molecular nitrogen (N2*). InN films grown on (0001) sapphire/GaN with higher relative molecular content were found to have lower carrier concentrations than the corresponding films grown with higher atomic content. However, electrical properties of films grown on (111) YSZ showed insensitivity to the active nitrogen content. Etching experiments revealed that films grown on sapphire/GaN were nitrogen-polar, while films grown on YSZ were In-polar, suggesting that film polarity can greatly influence the effect active species have on growth. Lattice relaxation, as measured by reflection high-energy electron diffraction, revealed that the N-polar films grown under high relative molecular flux relaxed fully after ∼60 nm of growth, while the corresponding In-polar film relaxed fully within the first several nm of growth.