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Cardiac catheterisations for CHD produce anxiety for patients and families. Current strategies to mitigate anxiety and explain complex anatomy include pre-procedure meetings and educational tools (cardiac diagrams, echocardiograms, imaging, and angiography). More recently, three-dimensionally printed patient-specific models can be added to the armamentarium. The purpose of this study was to evaluate the efficacy of pre-procedure meetings and of different educational tools to reduce patient and parent anxiety before a catheterisation.
Prospective study of patients ≥18 and parents of patients <18 scheduled for clinically indicated catheterisations. Patients completed online surveys before and after meeting with the interventional cardiologist, who was blinded to study participation. Both the pre- and post-meeting surveys measured anxiety using the State-Trait Anxiety Inventory. In addition, the post-meeting survey evaluated the subjective value (from 1 to 4) of individual educational tools: physician discussion, cardiac diagrams, echocardiograms, prior imaging, angiograms and three-dimensionally printed cardiac models. Data were compared using paired t-tests.
Twenty-three patients consented to participate, 16 had complete data for evaluation. Mean State-Trait Anxiety Inventory scores were abnormally elevated at baseline and decreased into the normal range after the pre-procedure meeting (39.8 versus 31, p = 0.008). Physician discussion, angiograms, and three-dimensional models were reported to be most effective at increasing understanding and reducing anxiety.
In this pilot study, we have found that pre-catheterisation meetings produce a measurable decrease in patient and family anxiety before a procedure. Discussions of the procedure, angiograms, and three-dimensionally printed cardiac models were the most effective educational tools.
Organophosphate insecticides, which have the capacity to inhibit specific herbicide-degrading (cytochrome P450) enzymes, have been used to explore metabolic herbicide-resistance mechanisms in weeds. This study investigates the response of seven field-selected rigid ryegrass (Lolium rigidum Gaudin) populations to herbicides from three different sites of action in the presence or absence of the P450 inhibitor phorate. Phorate antagonized the thiocarbamate herbicides triallate and prosulfocarb (8-fold increase in LD50) in multiple resistant L. rigidum populations with resistance to three different site-of-action herbicides. In contrast, phorate synergized trifluralin and propyzamide in some populations, reducing the LD50 by 50%. Conversely, treatment with phorate had no significant effect on the LD50 for S-metolachlor or pyroxasulfone (inhibitors of very-long-chain fatty-acid synthesis). Phorate has diverse effects that are herbicide and population dependant in field-selected L. rigidum, suggesting P450 involvement in the metabolism of trifluralin and failure to activate thiocarbamate herbicides in these populations. This research highlights the need for implementation of diverse approaches other than herbicide alone as part of a long-term integrated strategy to reduce the likelihood of metabolism-based resistance to PPI herbicides in L. rigidum.
Interactions between polyphenols and non-digestible carbohydrates (NDC) can impact on polyphenolic metabolites bioavailability, including phenolic acids. The BLEND2 trial (NCT03840746) aims to study longer-term interactions of a flavonoid-rich food with/without NDC on microbiota metabolites and cardiometabolic markers. Trial feasibility using a bespoke food was tested.
Material and Methods
The soup was developed locally containing cherry tomatoes, tomato puree, red onion, fresh lovage, with/without the NDC inulin (10g), but improved and processed with Campden BRI, Chipping Campden, UK. The final product (~400g/ tin) was evaluated with VAS scales (0–10) for appearance, smell, taste and overall palatability, and flavonoid content evaluated using liquid chromatography-mass spectrometry. The 3-arm parallel randomised blinded design (control soup, soup + inulin, habitual diet control) recruited self-reported healthy participants (BMI > 25, 40–70y) with urine, blood, faecal samples collected at baseline, 3-week, 6-weeks.
Both soups scored similarly (n = 8 testers) for visual appeal (with inulin 5.1 ± 2.1; without 4.5 ± 2.0); smell (with 5.9 ± 1.7; without 5.4 ± 0.8); taste (with 6.6 ± 2.0; without 5.5 ± 2.3), aftertaste (with 6.3 ± 2.9; without 5.4 ± 2.3) and overall palatability (with 7.0 ± 1.9; without 6.1 ± 2.1).
The soups (A&B), 1 tin/day, provide 68.5 ± 10.9 mg total flavonoids (soup A n = 3, quercetin equivalents) and 74.0 ± 16.1 mg (soup B, n = 3): quercetin (A 1.2 ± 0.1 mg; B 1.3 ± 0.6 mg), quercetin-4-glucoside (A 3.9 ± 1.0 mg; B 4.1 ± 1.9 mg), quercetin-3-rutinoside (A 23.0 ± 3.2 mg; B 20.5 ± 1.0 mg), quercetin 3,4-diglucosides (A 40.5 ± 6.9 mg; B 48.2 ± 14.9 mg).
Following notes of interest (n = 415), n = 111 attended screening, n = 34 did not proceed (medications, opt-out; 31%). Participants (n = 77) are mostly British (79%), median age 56y (IQR 49-62) with a median BMI of 31 (IQR 28-35). Dropout was low (12%) and early in the study (personal issues, n = 2; gastrointestinal issues, n = 2; failure to comply with protocol, n = 2; acid reflux symptoms, n = 1; dislike of test food, n = 1). Adverse events included acid reflux/heartburn (n = 4), gastrointestinal distress (n = 3) accounting for 3 drop-outs.
To date, urine, blood and faecal samples (study day or day + 1) were collected at all timepoints, for all participants. Participation (soup arms) has not led to body weight or blood lipids changes compared to control group.
The protocol for this 6-week trial has proved feasible with lower dropout than expected. Soup flavonoid content representing ~16% of average European flavonoid intakes, with inulin (10g) half the UK daily fibre intake. The soup was well accepted with few reports of adverse issues. Recruitment in this population is challenging, due to high levels of medication and ill health.
Most previous discussions of Ezra Pound, gender and sexuality have focused on Pound’s poetic depictions of women and his relationships with women artists, patrons and muses. The fascinating biographical stories include such figures as the poet H. D., perhaps Pound’s first love; the pianist and patron Margaret Cravens, who took her life after playing a song Pound and Walter Rummel wrote for her; Pound’s wife, Dorothy (Shakespear) Pound; and his long-time mistress, Olga Rudge, a concert violinist. When critics focus on sexuality and Pound, the result tends to be ‘paranoid’ rather than ‘reparative’ readings, to use Eve Sedgwick’s famous formulation.
Two field experiments were conducted during 2018 at Paskeville and Arthurton, South Australia, to identify effective herbicide options for the control of thiocarbamate-resistant rigid ryegrass in wheat. Dose–response experiments confirmed resistance in both field populations (T1 and A18) of rigid ryegrass to triallate, prosulfocarb, trifluralin, and pyroxasulfone. T1 and A18 were 17.9- and 20-fold more resistant to triallate than susceptible SLR4. The level of resistance detected in T1 to prosulfocarb (5.9-fold) and pyroxasulfone (4-fold) was lower compared to A18, which displayed 12.1- and 7.8-fold resistance to both herbicides, respectively. Despite resistance, the mixture of two different preplant-incorporated (PPI) site-of-action herbicides improved rigid ryegrass control and wheat yield compared to a single PPI herbicide only. Prosulfocarb + triallate and prosulfocarb + S-metolachlor + triallate did not reduce rigid ryegrass seed set when compared to prosulfocarb applied alone at the higher rate (2,400 g ai ha–1). Pyroxasulfone + triallate PPI followed by glyphosate (1,880 g ai ha-1) as a weed seed set control treatment reduced rigid ryegrass seed production by 93% and 95% at both sites, respectively. These herbicides also significantly improved grain yield of wheat at Paskeville (22%) and Arthurton (38%) compared to the untreated.
Patients’ experience of the quality of care received throughout their continuum of care can be used to direct quality improvement efforts in areas where they are most needed. This study aims to establish validity and reliability of the Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ) – a tool that collects patients’ experience that quantifies aspect of care used to make judgments about quality from the perspective of the Alberta Quality Matrix for Health (AQMH).
The AQMH is a framework that can be used to assess and compare the quality of care in different healthcare settings. The AQMH provides a common language, understanding, and approach to assessing quality. The HAPSQ is one tool that is able to assess quality of care according to five of six AQMH’s dimensions.
This was a prospective methodologic study. Between March and October 2015, a convenience sample of patients presenting with chronic full-thickness rotator cuff tears was recruited prospectively from the University of Calgary Sport Medicine Centre in Calgary, Alberta, Canada. Reliability of the HAPSQ was assessed using test–retest reliability [interclass correlation coefficient (ICC)>0.70]. Validity was assessed through content validity (patient interviews, floor and ceiling effects), criterion validity (percent agreement >70%), and construct validity (hypothesis testing).
Reliability testing was completed on 70 patients; validity testing occurred on 96 patients. The mean duration of symptoms was three years (SD: 5.0, range: 0.1–29). Only out-of-pocket utilization possessed an ICC<0.70. Patients reported that items were relevant and appropriate to measuring quality of care. No floor or ceiling effects were present. Criterion validity was reached for all items assessed. A priori hypotheses were confirmed. The HAPSQ represents an inexpensive, reliable, and valid approach toward collecting clinical information across a patient’s continuum of care.
Five populations of rigid ryegrass (Lolium rigidum Gaudin) from fields across cropping regions in southern Australia were suspected of having resistance to thiocarbamates, chloroacetamides, and sulfonylisoxazoline herbicides. Resistant (R) populations 375-14, 198-15, 16.2, EP162, RAC1, and A18 and two susceptible (S) populations (SLR4 and VLR1) were included in a dose–response study. All suspected R populations expressed resistance to one or all herbicides (thiocarbamates, chloroacetamides, and pyroxasulfone). Population 198-15 exhibited the highest LD50 to triallate (44.7-fold), prosulfocarb (45.7-fold), S-metolachlor (31.5-fold), and metazachlor (27.2-fold) compared with the S populations. Populations 198-15 and 375-14 were also resistant to pyroxasulfone (13.5- and 14.9-fold) compared with the S populations, as was population EP162. This study documents the first case of field-evolved resistance to thiocarbamate, chloroacetamide, and sulfonylisoxazoline herbicides in L. rigidum.
Recent infection testing algorithms (RITA) for HIV combine serological assays with epidemiological data to determine likely recent infections, indicators of ongoing transmission. In 2016, we integrated RITA into national HIV surveillance in Ireland to better inform HIV prevention interventions. We determined the avidity index (AI) of new HIV diagnoses and linked the results with data captured in the national infectious disease reporting system. RITA classified a diagnosis as recent based on an AI < 1.5, unless epidemiological criteria (CD4 count <200 cells/mm3; viral load <400 copies/ml; the presence of AIDS-defining illness; prior antiretroviral therapy use) indicated a potential false-recent result. Of 508 diagnoses in 2016, we linked 448 (88.1%) to an avidity test result. RITA classified 12.5% of diagnoses as recent, with the highest proportion (26.3%) amongst people who inject drugs. On multivariable logistic regression recent infection was more likely with a concurrent sexually transmitted infection (aOR 2.59; 95% CI 1.04–6.45). Data were incomplete for at least one RITA criterion in 48% of cases. The study demonstrated the feasibility of integrating RITA into routine surveillance and showed some ongoing HIV transmission. To improve the interpretation of RITA, further efforts are required to improve completeness of the required epidemiological data.
Landraces (including heritage varieties) are an important agrobiodiversity resource offering considerable value as a buffer against crop failures, as a crop for niche markets, and as a source of diversity for crop genetic improvement activities underpinning future food security. Home gardens are reservoirs of landrace diversity, but some of the accessions held in them are vulnerable or threatened with extinction. Those associated with seed saving networks have added security, for example, ca. 800 varieties are stored in the Heritage Seed Library (HSL) of Garden Organic, UK. In this study, Amplified Fragment Length Polymorphisms-based genetic analysis of accessions held in the HSL was used to (a) demonstrate the range of diversity in the collection, (b) characterize accessions to aid collection management and (c) promote broader use of the collection. In total, 171 accessions were included from six crops: Vicia faba L., Pisum sativum L., Daucus carota L., Cucumis sativus L., Lactuca sativa L. and Brassica oleracea L. var. acephala (DC.) Metzq. Average expected heterozygosity ranged from 0.18 to 0.28 in D. carota; 0.02–0.18 in P. sativum; 0.05–0.18 in L. sativa; 0.15–0.26 in B. oleracea var. acephala; 0.15–0.37 in C. sativus and 0.07–0.36 in V. faba. Genetic diversity and Fst values generally reflected the breeding system and cultivation history of the different crops. Comparisons of the diversity found in heritage varieties with that found in commercial varieties did not show a consistent pattern. Principal coordinates analysis and Unweighted Pair Group Method with Arithmetic Mean cluster analysis were used to identify four potential duplicate accession pairs.
A population of rigid ryegrass (Lolium rigidum Gaudin) from a field on the Eyre Peninsula, South Australia, was suspected of resistance to thiocarbamate herbicides. Dose–response studies were conducted on this population (EP162) and two susceptible populations (SLR4 and VLR1). The resistant population exhibited cross-resistance to triallate, prosulfocarb, EPTC, and thiobencarb with higher LD50 to triallate (14.9-fold), prosulfocarb (9.4-fold), EPTC (9.7-fold), and thiobencarb (13.6-fold) compared with the susceptible populations SLR4 and VLR1. The resistant population also displayed resistance to trifluralin, pyroxasulfone, and propyzamide. The LD50 of the resistant population was higher for trifluralin (13.8-fold), pyroxasulfone (8.1-fold), and propyzamide (2.7-fold) compared with the susceptible populations. This study documents the first case of field-evolved resistance to thiocarbamate herbicides in L. rigidum.
We present the first data release of the SkyMapper Southern Survey, a hemispheric survey carried out with the SkyMapper Telescope at Siding Spring Observatory in Australia. Here, we present the survey strategy, data processing, catalogue construction, and database schema. The first data release dataset includes over 66 000 images from the Shallow Survey component, covering an area of 17 200 deg2 in all six SkyMapper passbands uvgriz, while the full area covered by any passband exceeds 20 000 deg2. The catalogues contain over 285 million unique astrophysical objects, complete to roughly 18 mag in all bands. We compare our griz point-source photometry with Pan-STARRS1 first data release and note an RMS scatter of 2%. The internal reproducibility of SkyMapper photometry is on the order of 1%. Astrometric precision is better than 0.2 arcsec based on comparison with Gaia first data release. We describe the end-user database, through which data are presented to the world community, and provide some illustrative science queries.
Non-naturalist normative realists face an epistemological objection: They must explain how their preferred route of justification ensures a non-accidental connection between justified moral beliefs and the normative truths. One strategy for meeting this challenge begins by pointing out that we are semantically or conceptually competent in our use of the normative terms, and then argues that this competence guarantees the non-accidental truth of some of our first-order normative beliefs. In this paper, I argue against this strategy by illustrating that this competence based strategy undermines the non-naturalist's ability to capture the robustly normative content of our moral beliefs.
In the rapidly expanding literature on the ethics of climate engineering, a lot has been made of the fact that stratospheric aerosol injection would for the first time create a world whose climate had been intentionally shaped by deliberate human decisions. Intention has always mattered in ethics. Due to the importance of intention in assigning culpability for harms, one might expect that the moral responsibility for any harms created during an attempt to reconstruct the global climate using stratospheric aerosols would be considerable. This article investigates such an expectation by making a comparison between the culpability for any unintended harms resulting from stratospheric aerosol injection and culpability for the unintended harms already taking place due to carbon emissions. To make this comparison, both types of unintended harms are viewed through the lens of the doctrine of double effect. The conclusion reached goes against what many might expect. The article closes by suggesting that a good way to read this surprising conclusion is that it points toward the continuing moral importance of prioritizing emission reductions.
We calculate the luminosity of the synchrotron radiation from the vicinity of the light cylinder. We find that even if the thermal emission from the entire surface is included as the seed photon, the γ-ray to X-ray flux ratio for young pulsars is significantly higher than the observations. For these pulsars, most of γ-ray photons may be absorbed in the magnetosphere.
The standard shock acceleration model of pulsar wind nebulae (PWNe) does not account for the hard spectrum in radio wavelengths. The origin of the radio-emitting particles is also important to determine the pair production efficiency in the pulsar magnetosphere. Here, we propose a possible resolution for the particle energy distribution in PWNe; the radio-emitting particles are not accelerated at the pulsar wind termination shock but are stochastically accelerated by turbulence inside PWNe. We upgrade our past one-zone spectral evolution model including the energy diffusion, i.e., the stochastic acceleration, and apply to the Crab Nebula. For a particle injection to the stochastic acceleration process, we consider the continuous injection from the supernova ejecta or the impulsive injection associated with supernova explosion. The observed broadband spectrum and the decay of the radio flux are reproduced by tuning the amount of the particle injected to the stochastic acceleration process. Our results imply that some unveiled mechanisms, such as back reaction to the turbulence, are required to make the energies of stochastically and shock accelerated particles comparable.
Here we present a study of the radio frequency eclipses of the black widow pulsar J1810+1744 at low frequencies, where we are most sensitive to small deviations in the effects of material along the line of sight. Utilising the simultaneous dual beamforming and interferometric (imaging) mode of LOFAR High Band Antenna, pulsar flux variations throughout the orbit are compared for the two observing techniques to test for the presence of scattering and absorption at eclipse orbital phases. Dispersion measure and scattering variations are used as a sensitive probe into outermost edges of the eclipsing material surrounding the companion star. We find the eclipsing medium to be variable on timescales shorter than the 3.6 hr orbital period, and propose cyclotron-synchrotron absorption as the most likely primary eclipse mechanism.