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Introduction: Continued smoking by cancer patients causes adverse cancer treatment outcomes, but few patients receive evidence-based smoking cessation as a standard of care.
Aim: To evaluate practical strategies to promote wide-scale dissemination and implementation of evidence-based tobacco cessation services within state cancer centers.
Methods: A Collaborative Learning Model (CLM) for Quality Improvement was evaluated with three community oncology practices to identify barriers and facilitate practice change to deliver evidence-based smoking cessation treatments to cancer patients using standardized assessments and referrals to statewide smoking cessation resources. Patients were enrolled and tracked through an automated data system and received follow-up cessation support post-enrollment. Monthly quantitative reports and qualitative data gathered through interviews and collaborative learning sessions were used to evaluate meaningful quality improvement changes in each cancer center.
Results: Baseline practice evaluation for the CLM identified the lack of tobacco use documentation, awareness of cessation guidelines, and awareness of services for patients as common barriers. Implementation of a structured assessment and referral process demonstrated that of 1,632 newly registered cancer patients,1,581 (97%) were screened for tobacco use. Among those screened, 283 (18%) were found to be tobacco users. Of identified tobacco users, 207 (73%) were advised to quit. Referral of new patients who reported using tobacco to an evidence-based cessation program increased from 0% at baseline across all three cancer centers to 64% (range = 30%–89%) during the project period.
Conclusions: Implementation of quality improvement learning collaborative models can dramatically improve delivery of guideline-based tobacco cessation treatments to cancer patients.
Previous research shows that older men tend to have lower nutritional intakes and higher risk of under-nutrition compared with younger men. The objectives of this study were to describe energy and nutrient intakes, assess nutritional risk and investigate factors associated with poor intake of energy and key nutrients in community-dwelling men aged ≥75 years participating in the Concord Health and Ageing in Men Project – a longitudinal cohort study on older men in Sydney, Australia. A total of 794 men (mean age 81·4 years) had a detailed diet history interview, which was carried out by a dietitian. Dietary adequacy was assessed by comparing median intakes with nutrient reference values (NRV): estimated average requirement, adequate intake or upper level of intake. Attainment of NRV of total energy and key nutrients in older age (protein, Fe, Zn, riboflavin, Ca and vitamin D) was incorporated into a ‘key nutrients’ variable dichotomised as ‘good’ (≥5) or ‘poor’ (≤4). Using logistic regression modelling, we examined associations between key nutrients with factors known to affect food intake. Median energy intake was 8728 kJ (P5=5762 kJ, P95=12 303 kJ), and mean BMI was 27·7 (sd 4·0) kg/m2. Men met their NRV for most nutrients. However, only 1 % of men met their NRV for vitamin D, only 19 % for Ca, only 30 % for K and only 33 % for dietary fibre. Multivariate logistic regression analysis showed that only country of birth was significantly associated with poor nutritional intake. Dietary intakes were adequate for most nutrients; however, only half of the participants met the NRV of ≥5 key nutrients.
Although cattle movement and commingling play an important role in the inter-herd transmission of pathogens, little is known about the effect of commingling of heifers at raising operations. The objective of this study was to compare the resistance of E. coli and prevalence of Salmonella from pooled faecal pats of heifers raised off-farm at multi-source raisers (MULTI) that raised heifers from at least two farms compared with on-farm raisers (HOME), with heifers from only that farm. MULTI faecal pat samples were collected from pens with animals that had arrived at the farm within the previous 2 months (AP) and from animals that would be departing the heifer raiser in 2–3 months (DP). Corresponding age sampling was conducted at HOME raisers. Odds of ampicillin resistance were 3·0 times greater in E. coli collected from MULTI compared to HOME raisers. E. coli from AP pens had significantly (P < 0·05) higher odds of resistance to ampicillin, neomycin, streptomycin, and tetracycline compared to DP pens. Salmonella recovery was not significantly different between heifer-raising systems (P = 0·3). Heifer-raising system did not have a major overall impact on selection of resistant E. coli, which was strongly affected by the age of the animals sampled.
Computational Fluid Dynamics (CFD) has become an attractive method of choice in the design of many aerospace vehicles because of advances in numerical algorithms and convergence acceleration methods. However, the flow around an advanced fighter aircraft is complicated and usually unsteady due to the presence of vortex-dominated flows. The accuracy and predictability of conventional turbulence models for these applications may be questionable and therefore results obtained from these models must be validated and evaluated on the basis of experimental data from wind tunnels and/or flight tests. This work aims to validate CFD simulations of X-31 wind-tunnel models with and without a belly-mounted sting. The sting setup facilitates forced sinusoidal oscillations in one of three modes of: pitch, yaw, and roll. However, the results show that measured aerodynamic data are altered by the turbulent wake behind the sting, even at small angles of attack. The high angle-of-attack flow around the X-31 is also very complicated and unsteady due to canard and wing vortices. Therefore, validation of CFD models for predicting these complex flows can be a very challenging task. The X-31 wind-tunnel experiments were carried out in the German Dutch low-speed wind tunnel at Braunschweig and include aerodynamic force and moment measurement as well as span-wise pressure distributions at locations of 60% and 70% chord length. This data set is used to validate the Cobalt and Kestrel flow solvers and the results are similar and match quiet well with experiments for small to moderate angles of attack. The main discrepancies between CFD and measurements occur close to the wing tip, where leading-edge flaps are located.
Newcastle disease (ND) is one of the most important poultry diseases worldwide and can lead to annual losses of up to 80% of backyard chickens in Africa. All bird species are considered susceptible to ND virus (NDV) infection but little is known about the role that wild birds play in the epidemiology of the virus. We present a long-term monitoring of 9000 wild birds in four African countries. Overall, 3·06% of the birds were PCR-positive for NDV infection, with prevalence ranging from 0% to 10% depending on the season, the site and the species considered. Our study shows that ND is circulating continuously and homogeneously in a large range of wild bird species. Several genotypes of NDV circulate concurrently in different species and are phylogenetically closely related to strains circulating in local domestic poultry, suggesting that wild birds may play several roles in the epidemiology of different NDV strains in Africa. We recommend that any strategic plan aiming at controlling ND in Africa should take into account the potential role of the local wild bird community in the transmission of the disease.
This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.
We describe the current, 9-spacecraft Interplanetary Network (IPN). The IPN detects about
325 gamma-ray bursts per year, of which about 100 are not localized by any other missions.
We give some examples of how the data, which are public, can be utilized.
Previous work reports an association between familial risk factors stemming from parental characteristics and offspring disruptive behavior disorders (DBDs). This association may reflect (a) the direct effects of familial environment and (b) a passive gene–environment correlation (rGE), wherein the parents provide both the genes and the environment. The current study examined the contributions of direct environmental influences and passive rGE by comparing the effects of familial risk factors on child DBDs in genetically related (biological) and non-related (adoptive) families.
Participants were 402 adoptive and 204 biological families. Familial environment was defined as maternal and paternal maladaptive parenting and antisociality, marital conflict and divorce; offspring DBDs included attention deficit hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD). Mixed-level regressions estimated the main effects of familial environment, adoption status and the familial environment by adoption status interaction term, which tested for the presence of passive rGE.
There was a main effect of maternal and paternal maladaptive parenting and marital discord on child DBDs, indicating a direct environmental effect. There was no direct environmental effect of maternal or paternal antisociality, but maternal and paternal antisociality had stronger associations with child DBDs in biological families than adoptive families, indicating the presence of a passive rGE.
Many familial risk factors affected children equally across genetically related and non-related families, providing evidence for direct environmental effects. The relationship of parental antisociality and offspring DBDs was best explained by a passive rGE, where a general vulnerability toward externalizing psychopathology is passed down by the parents to the children.
Guidelines for treating various conditions can be helpful in setting practice standards, but the presence of several sets of guidelines from different countries, experts, and settings, written at different times, can also create confusion. Here we provide a “guideline of guidelines” for the treatment of schizophrenia, or “meta-guidelines,” which not only reconcile the various existing standards but also update them to include the use of several newer agents, most of which were marketed following the publication of existing standards.
Alzheimer's disease (AD) is an urgent public health challenge that is rapidly approaching epidemic proportions. New therapies that defer or prevent the onset, delay the decline, or improve the symptoms are urgently needed. All phase 3 drug development programs for disease-modifying agents have failed thus far. New approaches to drug development are needed. Translational neuroscience focuses on the linkages between basic neuroscience and the development of new diagnostic and therapeutic products that will improve the lives of patients or prevent the occurrence of brain disorders. Translational neuroscience includes new preclinical models that may better predict human efficacy and safety, improved clinical trial designs and outcomes that will accelerate drug development, and the use of biomarkers to more rapidly provide information regarding the effects of drugs on the underlying disease biology. Early translational research is complemented by later stage translational approaches regarding how best to use evidence to impact clinical practice and to assess the influence of new treatments on the public health. Funding of translational research is evolving with an increased emphasis on academic and NIH involvement in drug development. Translational neuroscience provides a framework for advancing development of new therapies for AD patients.
The LLW Repository Limited has recognised the potential importance of the processes being considered in the BIOPROTA 14C working group and funded the development a new 14C model that addresses the exchange of gas in a soil-plant-atmosphere system. This model considers two regions in the above-ground atmosphere and utilises concepts from the field of micrometeorology to describe the exchange of air between these regions and losses from the area of interest. The lower layer only experiences molecular diffusion processes in relation to the movement of molecules of CO2, whereas the upper layer experiences some degree of turbulent mixing as a result of winds which flow over the area of interest. The thicknesses of these layers depend upon the canopy density, which will affect the light intensity and thus the rate of photosynthetic uptake of carbon in the canopy profile. Model results demonstrate the impacts of 14C-labelled gas from the soil upon the calculated 14C concentration in plants for a variety of plant species (pasture and garden crops) and subsequent doses to human exposure groups. The technical modelling work described has been funded by the LLW Repository Ltd in support of its 2011 Environmental Safety Case.
Electrically conducting palladium features have been produced by laser and ion beam irradiation of thin palladium acetate films. The photothermal reaction induced by scanned continuous wave Ar+ laser irradiation leads to metal lines that may exhibit periodic structure. This results from repeated propagation of “explosive” reaction fronts generated by coupling of the heat from the absorbed laser radiation with the heat of the decomposition reaction of the film. In contrast, 2 MeV He+ ion irradiation produces smooth metallic-looking features that contain up to 20% of the original carbon and 5% of the original oxygen content of the film. Films irradiated with 2 MeV Ne+ ions contain slightly lower amounts of carbon and oxygen residues, but fully exposed thick films (0.90 μm) appear black rather than metallic silver. In addition to having significantly higher purity, the laser-written features have lower resistivities than the ion beam-irradiated features. Infrared spectroscopy of the ion beam-irradiated films as a function of dose indicates a progressive loss in intensity of the characteristics acetate (COO-) vibrations. This occurs at doses lower than those associated with major C and O loss from the films. Partially ion-exposed films continue to decompose to metallic-looking material over a period of weeks after irradiation. Metallic palladium particles apparently catalyze this process.
Fine conducting features have been produced on Si and SiO2 substrates by irradiation of spin-on palladium acetate, [Pd(O2CCH3)2]3 films with a submicron focused ion beam. The exposures were made with a 20 keV Ga+, focused to a 0.2 micrometer spot. Electrical conductivity measuremnents were made on the resultant features as a function of ion dose for linewidths of one and ten micrometers. The sheet conductivity in the two cases was comparable and increased dramatically in the dose range between 2×1014 and 5×1014 ions/cm2. The conductivity of the exposed lines was further increased after heating in a hydrogen atmosphere. Measurements of carbon and oxygen content indicate that even at the highest ion doses a significant amount of organic material remains. Results are compared to those for 2 MeV He+ and Ne+ broad beam exposures. Potential applications are also discussed.
3C-SiC, lattice-matched with TiC, is a candidate for use in wide-bandgap semiconductor devices. Epitaxial 3C-SiC films were grown on (111) and (112) TiC substrates, and defects were characterized by analytical TEM.
Radiogenic iodine is one of the more difficult fission products to capture and immobilize during the reprocessing of spent nuclear fuel.
However, for metallic fuels reprocessed by electrometallurgical treatment, it is believed that the majority of fission-product iodine is retained during the various processing steps. Spent fuel from the Experimental Breeder Reactor II (EBR-II) at the Idaho National Laboratory (INL) is being treated by a combination of electrochemical and pyrometallurgical methods to deactivate the bond sodium of the fuel, recover uranium, and immobilize fission products for disposal. This paper discusses the progress of various strategies and experiments to confirm the expected retention of iodine during the electrometallurgical treatment of EBR-II spent fuel. This includes surveys of previous observations and measurements, and the direct measurement of iodine from various process samples. Current measurements are aimed at iodine determination in the bond sodium and plenum regions of the fuel, refined iodine measurements in electrorefiner salt, and the retention of iodine during waste form production.