To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Research participants want to receive results from studies in which they participate. However, health researchers rarely share the results of their studies beyond scientific publication. Little is known about the barriers researchers face in returning study results to participants.
Using a mixed-methods design, health researchers (N = 414) from more than 40 US universities were asked about barriers to providing results to participants. Respondents were recruited from universities with Clinical and Translational Science Award programs and Prevention Research Centers.
Respondents reported the percent of their research where they experienced each of the four barriers to disseminating results to participants: logistical/methodological, financial, systems, and regulatory. A fifth barrier, investigator capacity, emerged from data analysis. Training for research faculty and staff, promotion and tenure incentives, and funding agencies supporting dissemination of results to participants were solutions offered to overcoming barriers.
Study findings add to literature on research dissemination by documenting health researchers’ perceived barriers to sharing study results with participants. Implications for policy and practice suggest that additional resources and training could help reduce dissemination barriers and increase the return of results to participants.
Introduction: ex-specific diagnostic cutoffs may improve the test characteristics of high-sensitivity troponin assays for the diagnosis of myocardial infarction. Sex-specific cutoffs for ruling in MI improve the sensitivity of the assay for MI among women, and improve the specificity of diagnosis among men. We hypothesized that the use of sex-specific high-sensitivity Troponin T (hsTnT) cutoffs for ruling out MI at the time of ED arrival would improve the classification efficiency of the assay by enabling more patients to have MI ruled out at the time of ED arrival while maintaining diagnostic sensitivity. The objective of this study was to quantify the test characteristics of sex-specific cutoffs of an hsTnT assay for acute myocardial infarction (AMI) when performed at ED arrival in patients with chest pain. Methods: This retrospective study included consecutive ED patients with suspected cardiac chest pain evaluated in four urban EDs were, excluding those with ST-elevation AMI, cardiac arrest or abnormal kidney function. The primary outcomes was AMI at 7 days. Secondary outcomes included major adverse cardiac events (MACE: all-cause mortality, AMI and revascularization) and the individual MACE components. We quantified test characteristics (sensitivity, negative predictive value, likelihood ratios and proportion of patients ruled out) for multiple combinations of sex-specific rule-out cutoffs. We calculated net reclassification improvement compared to universal rule-out cutoffs of 5ng/L (the assays limit of detection) and 6ng/L (the FDA-approved limit of quantitation for US laboratories). Results: 7130 patients, including 3931 men and 3199 women, were included. The 7-day incidence of AMI was 7.38% among men and 3.78% among women. Universal cutoffs of 5 and 6 ng/L ruled out AMI with 99.7% sensitivity in 33.6 and 42.2% of patients. The best-performing combination of sex-specific cutoffs (8g/L for men and 6ng/L for men) ruled out AMI with 98.7% sensitivity in 51.9% of patients. Conclusion: Sex-specific hsTnT cutoffs for ruling out AMI at ED arrival may achieve substantial improvement in classification performance, enabling more patients to be ruled out at ED arrival, while maintaining acceptable diagnostic sensitivity for AMI. Universal and sex-specific rule-out cutoffs differ by only small changes in hsTnT concentration. Therefore, these findings should be confirmed in other datasets.
Introduction: Patients with chronic kidney disease (CKD) are at high risk of cardiovascular events, and have worse outcomes following acute myocardial infarction (AMI). Cardiac troponin is often elevated in CKD, making the diagnosis of AMI challenging in this population. We sought to quantify test characteristics for AMI of a high-sensitivity troponin T (hsTnT) assay performed at emergency department (ED) arrival in CKD patients with chest pain, and to derive rule-out cutoffs specific to patient subgroups stratified by estimated glomerular filtration rate (eGFR). We also quantified the sensitivity and classification performance of the assays limit of detection (5 ng/L) and the FDA-approved limit of quantitation (6 ng/L) for ruling out AMI at ED arrival. Methods: Consecutive patients in four urban EDs from the 2013 calendar year with suspected cardiac chest pain who had a Roche Elecsys hsTnT assay performed on arrival were included f. This analysis was restricted to patients with an eGFR< 60 ml/min/1.73m2. The primary outcome was 7-day AMI. Secondary outcomes included major adverse cardiac events (death, AMI and revascularization). Test characteristics were calculated and ROC curves were generated for eGFR subgroups. Results: 1416 patients were included. 7-day AMI incidence was 10.1%. 73% of patients had an initial hsTnT concentration greater than the assays 99th percentile (14 ng/L). TCurrently accepted cutoffs to rule out MI at ED arrival ( 5 ng/L and 6 ng/L) had 100% sensitivity for AMI, but no patients with an eGFR less than 30 ml/min/1.73M had hsTnT concentrations below these thresholds. We derived eGFR-adjusted cutoffs to rule out MI with sensitivity >98% at ED arrival, which were able to rule out 6-42% of patients, depending on eGFR category. The proportion of patients able to be accurately ruled-in with a single hsTnT assay was substantially lower among patients with an eGFR <30 ml/min/1.73m2 (6-20% vs 25-43%). We also derived eGFR-adjusted cutoffs to rule-in AMI with specificity >90%, which accurately ruled-in up to 18% of patients. Conclusion: Cutoffs achieving acceptable diagnostic performance for AMI using single hsTnT sampling on ED arrival may have limited clinical utility, particularly among patients with very low eGFR. The ideal diagnostic strategy for AMI in patients with CKD likely involves serial high-sensitivity troponin testing with diagnostic thresholds customized to different eGFR categories.
The cathodo-luminescence of minerals in thin sections of rocks has been examined with the aid of an electron-probe microanalyser and also with a simple electron source producing an unfocused beam. Experimental details of the technique are briefly described and colour photographs, taken at a primary magnification of 30 times, are included. The observed variations in colour and intensity of luminescence are interpreted in the light of electron-probe and spectrochemical determinations of trace elements. Applications of the technique are discussed.
We consider pressure-driven flow of an ion-carrying viscous Newtonian fluid through a non-uniformly shaped channel coated with a charged deformable porous layer, as a model for blood flow through microvessels that are lined with an endothelial glycocalyx layer (EGL). The EGL is negatively charged and electrically interacts with ions dissolved in the blood plasma. The focus here is on the interplay between electrochemical effects, and the pressure-driven flow through the microvessel. To analyse these effects we use triphasic mixture theory (TMT) which describes the coupled dynamics of the fluid phase, the elastic EGL, ion transport within the fluid and electric fields within the microvessel. The resulting equations are solved numerically using a coupled boundary–finite element method (BEM-FEM) scheme. However, in the physiological regime considered here, ion concentrations and electric potentials vary rapidly over a thin transitional region (Debye layer) that straddles the lumen–EGL interface, which is difficult to resolve numerically. Accordingly we analyse this region asymptotically, to determine effective jump conditions across the interface for BEM-FEM computations within the bulk EGL/lumen. Our results demonstrate that ion–EGL electrical interactions can influence the near-wall flow, causing it to become reversed. This alters the stresses exerted upon the vessel wall, which has implications for the hypothesised role of the EGL as a transmitter of mechanical signals from the blood flow to the endothelial vessel surface.
The effects of soluble fiber inclusion in gestation diets with varying fermentation characteristics (fermentation kinetics and short-chain fatty acids (SCFA)-profile) on lactational feed intake of sows and their piglet growth over two parities were investigated using an in vitro–in vivo methodology. After breeding, 90 multiparous Landrace sows were randomized to one of three experimental diets: the control (CON) diet, konjac flour (KF) diet or sugar beet pulp (SBP) diet. All diets had similar levels of net energy, CP, insoluble fiber and NDF, but KF and SBP diets had higher soluble fiber levels than the CON diet. During gestation, the sows were restrictively fed with three different diets, but during lactation, all the sows were similarly fed ad libitum. The three gestation diets were enzymatically hydrolyzed using pepsin and pancreatin, and enzymolyzed residues were used in in vitro fermentation. Gas and SCFA production were monitored during fermentation. After fermentation, enzymolyzed residues of KF or SBP diets resulted in higher final asymptotic gas volume than those of the CON diet. The enzymolyzed residues of KF diet were mainly part of rapidly fermented fractions, whereas those of SBP diet were mainly part of slowly fermented fractions. In addition, the acetic acid, butyric acid and total SCFA concentrations of enzymolyzed residues of KF diet were higher (P<0.01) than the control and SBP diets. In the in vivo studies, on day 90 of gestation, the KF diet sows had higher plasma SCFA concentration (P<0.05) at 4 h after feeding than the CON diet sows. Furthermore, the KF diet sows had lower plasma free fatty acid (FFA) concentration (P<0.01) at 4 h after feeding, and a lower value of homeostasis model assessment (HOMA)-insulin resistance (P<0.05), but a higher value of HOMA-insulin sensitivity (P<0.01). The KF diet sows also consumed more feed during lactation (P<0.01) and weaned significantly heavier pigs (P<0.01) than the CON diet sows. The overall results showed that the high fermentation capacity KF diet contributed to an increased lactational feed intake and improved performance of piglets in the second reproductive cycle.
Previous studies in sheep and cattle have demonstrated that the urinary excretion of purine derivatives (PD) provides an index of the intestinal flow of microbial protein (Chen et al. 1990). Yak is the most important ruminant species in Tibetan Plateau. It was of interest to establish whether the approach of PD excretion to estimate microbial protein supply is applicable in yaks. The objective of this work is to measure the effect of fasting and different levels of feeding on PD excretion in yaks.
The feeding experiments were carried out in Xi-ning, China at an altitude of 3100m and a latitude of 36.8° N. Six 5-year old female yaks were used and 3 experiments were completed.
Recent reviews highlight the importance of the liver in the coordination of nutrient fluxes in support of pregnancy and lactation (e.g. Drackley et al., 2001). Mobilisation of body fat reserves in the late dry period and early lactation leads to an increase in uptake of non-esterified fatty acids (NEFA) by the liver. Their metabolic fate is either oxidation or esterification into triacylglycerides (TAG) that are either exported in very low density lipoproteins (VLDL) or accumulated within liver cells. Recent evidence indicates that TAG accumulation impairs ureagenic and gluconeogenic capacity of the liver, with consequent reductions in feed intake and milk yield, increased incidence of disease and decreased reproductive performance (Overton and Piepenbrink, 1999).
LiFTTM (NuTec Ltd.) is a proprietary mixture of B-group vitamins and methyl group donors (rumen protected choline, niacin, vitamin B12, biotin, folic acid and thiamine) designed to reduce the accumulation of TAG in the liver and accelerate VLDL export. The objective of this experiment was to evaluate the effect of LiFT on milk yield and composition and concentrations of metabolites in blood.
Persistent katabatic winds form widely distributed localized areas of near-zero net surface accumulation on the East Antarctic ice sheet (EAIS) plateau. These areas have been called 'glaze' surfaces due to their polished appearance. They are typically 2-200 km2 in area and are found on leeward slopes of ice-sheet undulations and megadunes. Adjacent, leeward high-accumulation regions (isolated dunes) are generally smaller and do not compensate for the local low in surface mass balance (SMB). We use a combination of satellite remote sensing and field-gathered datasets to map the extent of wind glaze in the EAIS above 1500 m elevation. Mapping criteria are derived from distinctive surface and subsurface characteristics of glaze areas resulting from many years of intense annual temperature cycling without significant burial. Our results show that 11.2 ± 1.7%, or 950 ± 143 × 103km2, of the EAIS above 1500 m is wind glaze. Studies of SMB interpolate values across glaze regions, leading to overestimates of net mass input. Using our derived wind-glaze extent, we estimate this excess in three recent models of Antarctic SMB at 46-82 Gt. The lowest-input model appears to best match the mean in regions of extensive wind glaze.
Optical identifications of 32 X-ray sources in the Magellanic Clouds confirm that they are SNRs. They are separated into four classes: the evolved, the oxygen-rich, the Balmer-dominated and the Crab-like. High velocity HI emission is observed from an extended region near 0525–66.0. It is suggested that this is produced by a possible Type III supernova which occurred out of the plane of the LMC and on the far side of the disk. The cumulative number-diameter relation for the LMC SNRs shows that they have evolved much faster than expected from the Sedov theory. It is suggested that this apparent “free-expansion” up to quite large diameters is due to the gradual conversion of the kinetic energy of the ejecta into thermal energy as they overtake the decelerating blast wave.
We report the optical identification of four Balmer-dominated supernova remnants (SNRs) in the Large Magellanic Cloud. Both the Balmer-dominated spectra and the presence of a broad Hα component in one remnant can be understood in terms of a very high velocity non-radiative shock encountering gas which is partially neutral, as proposed originally by Chevalier and Raymond to account for the similar spectra of the galactic remnants, Tycho and SN1006. From a consideration of the optical and X-ray luminosities of the SNR with broad Hα emission, we infer that the fraction of neutral gas in the medium is ≲ 30%. Radio observations of the LMC remnants show that their surface brightnesses are anomalously low; this could be intrinsic to the supernova themselves, or a result of their environment. Finally, we argue that the four SNRs all resulted from Type I supernovae, in which case they are the first such remnants to be identified outside the Galaxy.
We conducted a longitudinal assessment in 466 underweight and 446 normal-weight children aged 6–24 months living in the urban slum of Dhaka, Bangladesh to determine the association between vitamin D and other micronutrient status with upper respiratory tract infection (URI) and acute lower respiratory infection (ALRI). Incidence rate ratios of URI and ALRI were estimated using multivariable generalized estimating equations. Our results indicate that underweight children with insufficient and deficient vitamin D status were associated with 20% and 23–25% reduced risk of URI, respectively, compared to children with sufficient status. Underweight children, those with serum retinol deficiency were at 1·8 [95% confidence interval (CI) 1·4–2·4] times higher risk of ALRI than those with retinol sufficiency. In normal-weight children there were no significant differences between different vitamin D status and the incidence of URI and ALRI. However, normal-weight children with zinc insufficiency and those that were serum retinol deficient had 1·2 (95% CI 1·0–1·5) times higher risk of URI and 1·9 (95% CI 1·4–2·6) times higher risk of ALRI, respectively. Thus, our results should encourage efforts to increase the intake of retinol-enriched food or supplementation in this population. However, the mechanisms through which vitamin D exerts beneficial effects on the incidence of childhood respiratory tract infection still needs further research.
The lithium reagent used in the synthesis of benzene for 14C dating contributes insignificant 14C in high-precision measurements on 7 g benzene samples. Blank experiments on three different batches of lithium yielded small amounts of carbon, most of which probably originated as “memory” in the reaction vessel.
Radiocarbon dating with accelerators requires the manufacture of suitable carbon targets. Carbon yield and 13C fractionation were investigated for the simple and direct pyrolysis of wood and cellulose to charcoal. Under continuous vacuum removal of evolved volatiles, carbon yields of 35 to 40% and δ13C fractionation of −2.5‰ were observed in the pyrolysis of wood to charcoal, whereas yields of 30% and fractionation of −0.8‰ were obtained in the pyrolysis of cellulose to charcoal. Yield and fractionation leveled off at temperatures above 300°C. Yields and fractionations were also measured for pyrolysis of wood and cellulose in a continously-flowing argon atmosphere. Yields were higher and fractionations smaller than for the corresponding vacuum cases. For cellulose sealed in evacuated glass tubes and pyrolized at 550 to 600°C, carbon yields greater than 60% and fractionation of about −0.5‰ were observed. Yields increased and fractionation tended to decrease as the ratio of tube volume/mass of cellulose decreased, ie, as the pressure increased. Reheating of this charcoal under continuous vacuum pumping revealed no loss of mass and no alteration of carbon isotopic composition. Fractionation measurements were additionally performed on wood and the charcoal produced from burning in a fireplace, conditions approximating the “natural“ production of charcoal. Despite the large potential fractionation suggested in the wood pyrolysis experiments, charcoal produced in the fireplace showed very small or no fractionation.
Coeval shell and charcoal from Santa Catarina State, Brazil, differ systematically in 14C content, indicating a reservoir effect in marine samples. For modern samples (AD 1939–2000) and archeological samples (2500–1595 BP), the mean 14C age difference between marine and atmospheric carbon is 220 ± 20 years, the marine carbon being older. For three samples dated AD 1939–1944, a distinct reservoir correction of 510 ± 10 years is also observed. The ages of archeological shell samples from Jabuticabeira may be corrected by subtracting 220 years from the apparent 14C ages.
Antarctica Bedmap2 datasets are used to calculate subglacial hydraulic potential and the area, depth and volume of hydraulic potential sinks. There are over 32 000 contiguous sinks, which can be thought of as predicted lakes. Patterns of subglacial melt are modelled with a balanced ice flux flow model, and water fluxes are cumulated along predicted flow pathways to quantify steady-state fluxes from the main basin outlets and from known subglacial lakes. The total flux from the continent is ~21 km3 a−1. Byrd Glacier has the greatest basin flux of ~2.7 km3 a−1. Fluxes from subglacial lakes range from ~1 × 10−4 to ~1.5 km3 a−1. Lake turnover times are calculated from their volumes and fluxes, and have median values of ~100 a for known ‘active’ lakes and ~500 a for other lakes. Recurrence intervals of a 0.25 km3 flood range from ~2 months to ~2000 a (median ≈130 a) for known ‘active’ lakes and from ~2 to ~2400 a (median ≈ 360 a) for other lakes. Thus, several lakes that have recently been observed to fill and drain may not do so again for many centuries; and several lakes that have not, so far, been observed to fill and drain have the potential to do so, even at annual to decadal timescales.
The endothelial glycocalyx layer (EGL) is a macromolecular layer that lines the inner surface of blood vessels. It is believed to serve a number of physiological functions in the microvasculature, including protection of the vessel walls from potentially harmful levels of fluid shear, as a molecular sieve that acts to regulate transendothelial mass transport, and as a transducer of mechanical stress from the vessel lumen. To best fulfil some of its roles, it has been suggested that the EGL redistributes, so that it is thickest at the cell–cell junctions. It has also been suggested that the majority of mechanotransduction occurs through the solid phase of the EGL, rather than via its fluid phase. The difficulties associated with measuring the distribution of the EGL in vivo make these hypotheses difficult to confirm experimentally. Consequently, to gauge the impact of EGL redistribution from a theoretical standpoint, we compute the flow through a porous-lined microvessel, the endothelial surface of which has been informed by confocal microscopy images of a postcapillary venule. Following earlier studies, we model the poroelastohydrodynamics of the EGL using biphasic mixture theory, taking advantage of a recently developed boundary integral representation of these equations to solve the coupled poroelastohydrodynamics using the boundary element method. However, the low permeabilities of the EGL mean that viscous effects are confined to thin layers, thereby also enabling an asymptotic treatment of the dynamics in this limit. In this asymptotic regime, we also consider a two-layer Stokes flow model for the lumen flow to approximate the effect of red blood cells within the lumen. We demonstrate that redistribution of the EGL can have a substantial impact upon microvessel haemodynamics. We also confirm that the bulk of the mechanical stress is indeed carried through the solid phase of the EGL.