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In order to fully participate in informed consent, patients must understand what it is that they are agreeing, or not agreeing, to. In most cases, patients look to their clinicians to help develop the appropriate understanding required to give informed consent. Often the quality of the information available as well as the delivery methods are not optimal.
Using a visual aid as an adjunct to risk communication in a stressful setting as the Emergency Department has a clear potential in facilitating the communication process. To support more accurate and consistent presentation of risk, we formed a team with implementation scientists, patient education specialists, nurses, physicians, and professional designers to transform the information available into a 6th grade reading level visual aid tool. We applied a DMAIC (Define, Measure, Analyze, Improve and Control) process to design the tool. We measured and analyzed its effectiveness through feedback from providers, patients, and caregivers. This cycle happened 3 times until we reached the final version of the visual aid.
We utilized a DMAIC methodology as well as modified Delphi method to create and refine a visual aid tool. Several rounds of end-user feedback along with DMAIC allowed us to create a tool that was consistently better with each round of development, analysis and feedback. After arriving at the final version of the tool, we surveyed physicians in our Emergency Department. We measured the difficulty to understand the information, whether doctors think the visual aid will help patients to understand the data, and the appropriateness of the tool’s length and the amount of information in it.
We believe that our experience can be replicated by other researchers and clinicians in the endeavor of translating the evidence into clinical practice. An effort should be made to fully translate research findings until the end of the research to practice continuum in order to better translate knowledge into a useful and useable form for informed consent decisions in busy clinical practice.
We study the effects of mergers on non-parametric morphologies of galaxies. We compute the Gini index, M20, asymmetry and concentration statistics for z = 0 galaxies in the Illustris simulation and compare non-parametric morphologies of major mergers, minor merges, close pairs, distant pairs and unperturbed galaxies. We determine the effectiveness of observational methods based on these statistics to select merging galaxies.
Evidence associating serum 25-hydroxyvitamin D (25(OH)D) concentrations and cardiometabolic risk factors is inconsistent and studies have largely been conducted in adult populations. We examined the prospective associations between serum 25(OH)D concentrations and cardiometabolic risk factors from adolescence to young adulthood in the West Australian Pregnancy Cohort (Raine) Study. Serum 25(OH)D concentrations, BMI, homoeostasis model assessment for insulin resistance (HOMA-IR), TAG, HDL-cholesterol and systolic blood pressure (SBP) were measured at the 17-year (n 1015) and 20-year (n 1117) follow-ups. Hierarchical linear mixed models with maximum likelihood estimation were used to investigate associations between serum 25(OH)D concentrations and cardiometabolic risk factors, accounting for potential confounders. In males and females, respectively, mean serum 25(OH)D concentrations were 73·6 (sd 28·2) and 75·4 (sd 25·9) nmol/l at 17 years and 70·0 (sd 24·2) and 74·3 (sd 26·2) nmol/l at 20 years. Deseasonalised serum 25(OH)D3 concentrations were inversely associated with BMI (coefficient −0·01; 95 % CI −0·03, −0·003; P=0·014). No change over time was detected in the association for males; for females, the inverse association was stronger at 20 years compared with 17 years. Serum 25(OH)D concentrations were inversely associated with log-HOMA-IR (coefficient −0·002; 95 % CI −0·003, −0·001; P<0·001) and positively associated with log-TAG in females (coefficient 0·002; 95 % CI 0·0008, 0·004; P=0·003). These associations did not vary over time. There were no significant associations between serum 25(OH)D concentrations and HDL-cholesterol or SBP. Clinical trials in those with insufficient vitamin D status may be warranted to determine any beneficial effect of vitamin D supplementation on insulin resistance, while monitoring for any deleterious effect on TAG.
The aim of this study was to investigate the activities of important enzymes involved in the phosphoryl transfer network (adenylate kinase and creatine kinase (CK)), lactate dehydrogenase (LDH), respiratory chain complexes and biomarkers of cardiac function in rat experimentally infected by Trypanosoma evansi. Rat heart samples were evaluated at 5 and 15 days post-infection (PI). At 5 day PI, there was an increase in LDH and CK activities, and a decrease in respiratory chain complexes II, IV and succinate dehydrogenase activities. In addition, on day 15 PI, a decrease in the respiratory chain complex IV activity was observed. Biomarkers of cardiac function were higher in infected animals on days 5 and 15 PI. Considering the importance of the energy metabolism for heart function, it is possible that the changes in the enzymatic activities involved in the cardiac phosphotransfer network and the decrease in respiratory chain might be involved partially in the role of biomarkers of cardiac function of T. evansi-infected rats.
The Vista Variables in the Vía Láctea (VVV) ESO Public Survey is an ongoing time-series, near-infrared (IR) survey of the Galactic bulge and an adjacent portion of the inner disk, covering 562 square degrees of the sky, using ESO's VISTA telescope. The survey has provided superb multi-color photometry in 5 broadband filters (Z, Y, J, H, and Ks), leading to the best map of the inner Milky Way ever obtained, particularly in the near-IR. The main part of the survey, which is focused on the variability in the Ks-band, is currently underway, with bulge fields observed between 34 and 73 times, and disk fields between 34 and 36 times. When the survey is complete, bulge (disk) fields will have been observed up to a total of 100 (60) times, providing unprecedented depth and time coverage in the near-IR. Here we provide a first overview of stellar variability in the VVV data.
Research into age of onset in obsessive–compulsive disorder (OCD) has indicated significant differences between patients with early and late onset of the disorder. However, multiple criteria have been used arbitrarily for differentiating between early- and late-onset OCD, rendering inconsistent results that are difficult to interpret.
In the current study, admixture analysis was conducted in a sample of 377 OC patients to determine the number of underlying populations of age of onset and associated demographic and clinical characteristics. Various measures of anxiety, depression, co-morbidity, autism, OCD, tics and attention deficit hyperactivity disorder (ADHD) symptoms were administered.
A bimodal age of onset was established and the best-fitting cut-off score between early and late age of onset was 20 years (early age of onset ⩽19 years). Patients with early age of onset were more likely to be single. Early age of onset patients demonstrated higher levels of OCD severity and increased symptoms on all OCD dimensions along with increased ADHD symptoms and higher rates of bipolar disorder.
It is suggested that 20 years is the recommended cut-off age for the determination of early versus late age of onset in OCD. Early age of onset is associated with a generally graver OCD clinical picture and increased ADHD symptoms and bipolar disorder rates, which may be related to greater functional implications of the disorder. We propose that age of onset could be an important marker for the subtyping of OCD.
A new beam-combination and detection system has been installed in the Sydney University Stellar Interferometer working at the red end of the visual spectrum (λλ 500–950 nm) to complement the existing blue-sensitive system (λλ 430–520 nm) and to provide an increase in sensitivity. Dichroic beam-splitters have been introduced to allow simultaneous observations with both spectral systems, albeit with some restriction on the spectral range of the longer wavelength system (λλ 550–760 nm). The blue system has been upgraded to allow remote selection of wavelength and spectral bandpass, and to enable simultaneous operation with the red system with the latter providing fringe-envelope tracking. The new system and upgrades are described and examples of commissioning tests presented. As an illustration of the improvement in performance the measurement of the angular diameter of the southern F supergiant δ CMa is described and compared with previous determinations.
Although usually thought of as external environmental stressors, a significant heritable component has been reported for measures of stressful life events (SLEs) in twin studies.
We examined the variance in SLEs captured by common genetic variants from a genome-wide association study (GWAS) of 2578 individuals. Genome-wide complex trait analysis (GCTA) was used to estimate the phenotypic variance tagged by single nucleotide polymorphisms (SNPs). We also performed a GWAS on the number of SLEs, and looked at correlations between siblings.
A significant proportion of variance in SLEs was captured by SNPs (30%, p = 0.04). When events were divided into those considered to be dependent or independent, an equal amount of variance was explained for both. This ‘heritability’ was in part confounded by personality measures of neuroticism and psychoticism. A GWAS for the total number of SLEs revealed one SNP that reached genome-wide significance (p = 4 × 10−8), although this association was not replicated in separate samples. Using available sibling data for 744 individuals, we also found a significant positive correlation of R2 = 0.08 in SLEs (p = 0.03).
These results provide independent validation from molecular data for the heritability of reporting environmental measures, and show that this heritability is in part due to both common variants and the confounding effect of personality.
We describe the relatively complete skeleton of Tetraclaenodon undoubtedly associated with its dentition, from the Torrejonian interval of the Nacimiento Formation in the San Juan Basin, New Mexico. Tetraclaenodon is the most primitive and oldest genus of the family Phenacodontidae and is very important for assessing the phylogenetic relationships of the family. The newly described skeleton belonged to a lightly built terrestrial mammal that could use trees for shelter. The structure of the ulna, manus, femur, crus, and pes corresponds to that of a typical terrestrial mammal, while morphological features such as the low greater tubercle of the humerus, long deltopectoral crest, pronounced lateral supracondylar crest, and hemispherical capitulum indicate some scansorial adaptations of Tetraclaenodon. The postcranial skeleton of Tetraclaenodon does not exhibit the cursorial adaptations seen in later phenacodontids and early perissodactyls. Phylogenetic analysis did not recover monophyletic “Phenacodontidae”; instead, phenacodontids formed a series of sister taxa to the Altungulata clade. Tetraclaenodon is the basal-most member of the “Phenacodontidae” + Altungulata clade.
Although there are indications for modulatory effects of PUFA on associations between SNP and obesity risk, scientific evidence in human subjects is still scarce. The present analyses investigated interaction effects between SNP in candidate genes for obesity and PUFA in erythrocyte membranes on obesity risk. Within the second Bavarian Food Consumption Survey (cross-sectional, population-based), 568 adults provided blood samples. Fatty acid composition of erythrocyte membranes was analysed by means of GC. Genotyping was performed for twenty-one genes, including cytokines, adipokines, neurotransmitters and transcription factors. In addition, plasma IL-6 concentrations were analysed. For the statistical analysis, a logistic regression model assuming additive genetic effects was chosen. About 20 % of the study participants were classified as obese (BMI ≥ 30 kg/m2). Several significant gene–PUFA interactions were found, indicating regulatory effects of PUFA by gene variants of IL-2, IL-6, IL-18, TNF receptor family member 1B and 21, leptin receptor and adiponectin on obesity risk. After stratification by genotype, the strongest effects were found for rs2069779 (IL-2) and all tested PUFA as well as for rs1800795 (IL-6) and linoleic or arachidonic acid. The obesity risk of minor allele carriers significantly decreased with increasing fatty acid content. The genetic PUFA–IL-6 interaction was also reflected in plasma IL-6 concentrations. If replicated in a prospective study with sufficient statistical power, the results would indicate a beneficial effect of high PUFA supply for a substantial proportion of the population with respect to obesity risk.
The Pressurized Water Reactor vessel steels are embrittled by neutron irradiation. Among the solute atoms, copper play an important role in the embrittlement and different Cu-rich defects have been experimentally observed to form. We have investigated by Kinetic Monte Carlo (KMC) on rigid lattices the evolution of the primary damage. Since the point defects created by the displacement cascades have very different kinetics, their evolution is tracked in two steps. In a first step, we have studied their recombination in the cascade region and the formation of interstitial clusters using “object diffusion”. The parameters of this model are based on MD simulations, or on first principles calculations. In a second part, we have investigated the subsequent evolution of the primary damage with a model based on a vacancy jump mechanism. These simulations which rely on an adapted EAM potential show the formation of copper rich defects. Some of the potential's predictions that played a key role in the model were checked by ab initio calculations. The defects obtained from these simulations, subsequent to the primary damage created by displacement cascades, exhibit similarities with the ones observed by atom probe. The influence of temperature and Cu content on the final damage was investigated.
Advances in computational capability and modeling techniques, as well as improvements in experimental characterization methods offer the possibility of directly comparing modeling and experiment investigations of irradiation effects in metals. As part of a collaboration among the Instituto de Fusión Nuclear (DENIM), Lawrence Livermore National Laboratory (LLNL) and CIEMAT, single and polycrystalline α-Fe samples have been irradiated with 150 keV Fe- ions to doses up to several dpa. The irradiated microstructure is to be examined with both transmission electron microscopy (TEM) and positron annihilation spectroscopy (PAS). Concurrently, we have modeled the damage accumulation in Fe under these irradiation conditions using a combination of molecular dynamics (MD) and kinetic Monte Carlo (KMC). We aim to make direct comparison between the simulation results and the experiments by simulating TEM images and estimating positron lifetimes for the predicted microstructures. While the identity of the matrix defect features cannot be determined from TEM observations alone, we propose that both large self-interstitial loops, trapped at impurities within the material, and small, spherical nanovoids form.
The ferritic/martensitic steels which are candidates for the first wall of the future fusion reactor are investigated in TEM. While the irradiation doses expected in this reactor are in the range of 100 dpa per year, there is still a lack of knowledge on the nature of the irradiation induced defects for the low doses at which hardening is already occuring. This hardening depends strongly on the type of interaction between the moving dislocations and the defects. The early defects, which start to appear as black dots in TEM, are expected to be either three dimensional clusters of interstitials or vacancies, or dislocation loops. The nature and size of these defects is carefully studied in the F82H steel for doses ranging from about 0.5 dpa to 9 dpa and irradiation temperatures ranging from 40°C to 330°C. For that purpose, various weak beam techniques are explored at the limit of resolution of a TEM used in diffraction mode. Results are presented here for the cases of a 1.7 dpa and a 8.8 dpa irradiation.
Implantation of dopant ions in SiC has evolved according to the assumption that the best electrical results (i.e., carrier concentrations and mobility) are achieved by using the highest possible processing temperature. This includes implantation at > 600°C followed by furnace annealing at temperatures as high as 1750°C. Despite such aggressive and extreme processing, implantation suffers because of poor dopant activation, typically ranging between < 2%–50% with p-type dopants represented in the lower portion of this range and n-types in the upper. Additionally, high-temperature processing can led to several problems including changes in the stoichiometry and topography of the surface, as well as degradation of the electrical properties of devices. A novel approach for increasing activation of implanted dopants in SiC and lowering the activation temperature will be discussed. This approach utilizes the manipulation of the ion-induced damage to enhance activation of implanted dopants. It will be shown that nearly amorphous layers containing a small amount of residual crystallinity can be recrystallized at temperatures below 900°C with little residual damage. It will be shown that recrystallization traps a high fraction of the implanted dopant residing within the amorphous phase (prior to annealing) onto substitutional sites within the SiC lattice.
As part of a broad effort to understand the mechanisms of irradiation embrittlement in reactor pressure vessels steels, irradiation hardening and microstructural evolution in simple model Fe-0.9Cu-1.0Mn, Fe-0.9Cu and Fe alloys irradiated with 3.2 MeV protons at 300°C are compared to the corresponding changes in hardening produced by neutron irradiation over a similar dose range of 0.0004 to 0.015 dpa. In the case of the proton irradiated samples, Vickers hardness was measured at a 25 g load and the microstructures were characterized using small angle x-ray scattering (SAXS). In spite of the much higher dpa rate for protons (3 × 10−7 dpa/s compared to neutron rates of about 10−9 to 10−10 dpa/s) as well as very different primary recoil spectra, the observed hardening-dose response is very similar in both cases. The large increase in hardness in the alloys with 0.9% copper, and the SAXS data are consistent with precipitation of coherent copper-rich features accelerated by irradiation enhanced diffusion, as well as a much smaller contribution presumably from defect clusters that do not require the presence of copper.
The objective of this work is to investigate the addition of misfit elements in both size and mass on the evolution of irradiated microstructure in 316 SS. Alloys were modified by the addition of Pt and Hf to suppress the radiation damage. Pt and Hf were added as a lattice perturbation to catalyze defect recombination within the early stage of cascade formation and defect migration. Irradiations were conducted with 5 MeV Ni-ions at 500 °C to doses up to 50 dpa or with 3.2 MeV protons at 400 °C. Microstructures were characterized using transmission electron microscopy. While no beneficial effect was seen for Pt addition, Hf appears to effectively alter the microstructural response to irradiation.