Should Sputum Smear Examination Be Carried Out at the End of the Intensive Phase and End of Treatment in Sputum Smear Negative Pulmonary TB Patients?

The Indian guidelines on following up sputum smear-negative Pulmonary tuberculosis (PTB) patients differ from the current World Health Organization (WHO) guidelines in that the former recommends two follow up sputum examinations (once at the end of intensive phase and the other at the end of treatment) while the latter recommends only one follow up sputum smear microscopy examination, which is done at the end of the intensive phase. This study was conducted to examine if there was any added value in performing an additional sputum smear examination at the end of treatment within the context of a national TB program

Stigma towards psychosis: cross-cultural differences in prejudice, stereotypes and discrimination in White British and South Asians

Public stigma towards people with mental health problems has been demonstrated in Western societies. Little is known about non-Western cultures and whether cultures differ in their perceptions of people with mental health problems. Aim of this study was to examine cultural differences in prejudice, stereotypes and discrimination towards people with psychosis. Participants were young people from White British and South Asian backgrounds (N = 128, aged 16-20 years) recruited from two schools and colleges in the UK. They completed a cross-sectional survey on affective, cognitive and behavioral dimensions of stigma. Results revealed significant cultural differences on all three stigma dimensions. South Asians attributed higher anger (prejudice) and dangerousness (stereotypes) to people with psychosis than White British. They also reported lower willingness to help, greater avoidance and higher endorsement of segregation (discrimination). The effects of ethnic group on helping intentions, avoidance and segregation endorsement were mediated by anger and by dangerousness. Understanding cultural differences in stigma towards psychosis will be important for designing stigma interventions as well as treatments for people with different cultural backgrounds

Selective interference: Emergent complexity informed by programmatic, social and performative criteria

Parametric design tools and visual programming languages are fast becoming an important part of the architects design process. A review of current literature notes that the barrier to entry into the medium is lowering while the power of the tools available is increasing. The purpose of this research is to use these emerging tools to explore complex architectural issues related to space planning and massing. This research aims to bring these aspects of the design process together to generate an architecture where programme and aesthetic are derived in equal measure by the architect and the computer. The project began with a series of technical studies focusing primarily on space planning, massing, site analysis and circulation with the purpose of using an amalgamation of these techniques to develop into a final generative algorithm. These ideas are explored through an open ended design process of iterative research and testing, self and peer review, development and critical reflection. The viability of the algorithm is then tested through the generation a number of test buildings, across variety of sites. In order to provide a direction and author a degree of creative friction within the research process, the projects are framed around the development of a mid-size, urban sited secondary school. The final algorithm provides constraints in such a way that the architecture evolves in a natural, predictable way that can still surprise and inform, as well as consistently producing viable, interesting iterations of buildings. This process, described as an “open box” structure, produced a wide variety of working concepts and provided a high level of control as a designer

Learning of Food Preferences: Mechanisms and Implications for Obesity & Metabolic Diseases

Omnivores, including rodents and humans, compose their diets from a wide variety of potential foods. Beyond the guidance of a few basic orosensory biases such as attraction to sweet and avoidance of bitter, they have limited innate dietary knowledge and must learn to prefer foods based on their flavors and postoral effects. This review focuses on postoral nutrient sensing and signaling as an essential part of the reward system that shapes preferences for the associated flavors of foods. We discuss the extensive array of sensors in the gastrointestinal system and the vagal pathways conveying information about ingested nutrients to the brain. Earlier studies of vagal contributions were limited by nonselective methods that could not easily distinguish the contributions of subsets of vagal afferents. Recent advances in technique have generated substantial new details on sugar- and fat-responsive signaling pathways. We explain methods for conditioning flavor preferences and their use in evaluating gut–brain communication. The SGLT1 intestinal sugar sensor is important in sugar conditioning; the critical sensors for fat are less certain, though GPR40 and 120 fatty acid sensors have been implicated. Ongoing work points to particular vagal pathways to brain reward areas. An implication for obesity treatment is that bariatric surgery may alter vagal function

Recovery-focused cognitive-behavioural therapy for recent-onset bipolar disorder:randomised controlled pilot trial

Background Despite evidence for the effectiveness of structured psychological therapies for bipolar disorder no psychological interventions have been specifically designed to enhance personal recovery for individuals with recent-onset bipolar disorder. Aims A pilot study to assess the feasibility and effectiveness of a new intervention, recovery-focused cognitive-behavioural therapy (CBT), designed in collaboration with individuals with recent-onset bipolar disorder intended to improve clinical and personal recovery outcomes. Method A single, blind randomised controlled trial compared treatment as usual (TAU) with recovery-focused CBT plus TAU (n = 67). Results Recruitment and follow-up rates within 10% of pre-planned targets to 12-month follow-up were achieved. An average of 14.15 h (s.d. = 4.21) of recovery-focused CBT were attended out of a potential maximum of 18 h. Compared with TAU, recovery-focused CBT significantly improved personal recovery up to 12-month follow-up (Bipolar Recovery Questionnaire mean score 310.87, 95% CI 75.00-546.74 (s.e. = 120.34), P = 0.010, d = 0.62) and increased time to any mood relapse during up to 15 months follow-up (χ(2) = 7.64, P<0.006, estimated hazard ratio (HR) = 0.38, 95% CI 0.18-0.78). Groups did not differ with respect to medication adherence. Conclusions Recovery-focused CBT seems promising with respect to feasibility and potential clinical effectiveness. Clinical- and cost-effectiveness now need to be reliably estimated in a definitive trial

Lattice Green functions in all dimensions

We give a systematic treatment of lattice Green functions (LGF) on the $d$-dimensional diamond, simple cubic, body-centred cubic and face-centred cubic lattices for arbitrary dimensionality $d \ge 2$ for the first three lattices, and for $2 \le d \le 5$ for the hyper-fcc lattice. We show that there is a close connection between the LGF of the $d$-dimensional hypercubic lattice and that of the $(d-1)$-dimensional diamond lattice. We give constant-term formulations of LGFs for all lattices and dimensions. Through a still under-developed connection with Mahler measures, we point out an unexpected connection between the coefficients of the s.c., b.c.c. and diamond LGFs and some Ramanujan-type formulae for $1/\pi.$Comment: 30 page

Enhanced X-ray variability from V1647 Ori, the young star in outburst illuminating McNeil's Nebula

We report a ~38 ks X-ray observation of McNeil's Nebula obtained with XMM on 2004 April 4. V1647 Ori, the young star in outburst illuminating McNeil's Nebula, is detected with XMM and appears variable in X-rays. We investigate the hardness ratio variability and time variations of the event energy distribution with quantile analysis, and show that the large increase of the count rate from V1647 Ori observed during the second half of the observation is not associated with any large plasma temperature variations as for typical X-ray flares from young low-mass stars. X-ray spectral fitting shows that the bulk (~75%) of the intrinsic X-ray emission in the 0.5-8 keV energy band comes from a soft plasma component (0.9 keV) reminiscent of the X-ray spectrum of the classical T Tauri star TW Hya, for which X-ray emission is believed to be generated by an accretion shock onto the photosphere of a low-mass star. The hard plasma component (4.2 keV) contributes ~25% of the total X-ray emission, and can be understood only in the framework of plasma heating sustained by magnetic reconnection events. We find a hydrogen column density of NH=4.1E22 cm-2, which points out a significant excess of hydrogen column density compared to the value derived from optical/IR observations, consistent with the picture of the rise of a wind/jet unveiled from ground optical spectroscopy. The X-ray flux observed with XMM ranges from roughly the flux observed by Chandra on 2004 March 22 (~10 times greater than the pre-outburst X-ray flux) to a value two times greater than that caught by Chandra on 2004 March 7 (~200 times greater than the pre-outburst X-ray flux). We have investigated the possibility that V1647 Ori displays a periodic variation in X-ray brightness as suggested by the combined Chandra+XMM data set (abridged).Comment: 11 pages and 8 Figures. Accepted for publication by Astronomy & Astrophysic

Learning to prescribe - pharmacists' experiences of supplementary prescribing training in England

Background: The introduction of non-medical prescribing for professions such as pharmacy and nursing in recent years offers additional responsibilities and opportunities but attendant training issues. In the UK and in contrast to some international models, becoming a non-medical prescriber involves the completion of an accredited training course offered by many higher education institutions, where the skills and knowledge necessary for prescribing are learnt. Aims: to explore pharmacists' perceptions and experiences of learning to prescribe on supplementary prescribing (SP) courses, particularly in relation to inter-professional learning, course content and subsequent use of prescribing in practice. Methods: A postal questionnaire survey was sent to all 808 SP registered pharmacists in England in April 2007, exploring demographic, training, prescribing, safety culture and general perceptions of SP. Results: After one follow-up, 411 (51%) of pharmacists responded. 82% agreed SP training was useful, 58% agreed courses provided appropriate knowledge and 62% agreed that the necessary prescribing skills were gained. Clinical examination, consultation skills training and practical experience with doctors were valued highly; pharmacology training and some aspects of course delivery were criticised. Mixed views on inter-professional learning were reported – insights into other professions being valued but knowledge and skills differences considered problematic. 67% believed SP and recent independent prescribing (IP) should be taught together, with more diagnostic training wanted; few pharmacists trained in IP, but many were training or intending to train. There was no association between pharmacists' attitudes towards prescribing training and when they undertook training between 2004 and 2007 but earlier cohorts were more likely to be using supplementary prescribing in practice. Conclusion: Pharmacists appeared to value their SP training and suggested improvements that could inform future courses. The benefits of inter-professional learning, however, may conflict with providing professionspecific training. SP training may be perceived to be an instrumental 'stepping stone' in pharmacists' professional project of gaining full IP status

The merger that led to the formation of the Milky Way's inner stellar halo and thick disk

The assembly process of our Galaxy can be retrieved using the motions and chemistry of individual stars. Chemo-dynamical studies of the nearby halo have long hinted at the presence of multiple components such as streams, clumps, duality and correlations between the stars' chemical abundances and orbital parameters. More recently, the analysis of two large stellar surveys have revealed the presence of a well-populated chemical elemental abundance sequence, of two distinct sequences in the colour-magnitude diagram, and of a prominent slightly retrograde kinematic structure all in the nearby halo, which may trace an important accretion event experienced by the Galaxy. Here report an analysis of the kinematics, chemistry, age and spatial distribution of stars in a relatively large volume around the Sun that are mainly linked to two major Galactic components, the thick disk and the stellar halo. We demonstrate that the inner halo is dominated by debris from an object which at infall was slightly more massive than the Small Magellanic Cloud, and which we refer to as Gaia-Enceladus. The stars originating in Gaia-Enceladus cover nearly the full sky, their motions reveal the presence of streams and slightly retrograde and elongated trajectories. Hundreds of RR Lyrae stars and thirteen globular clusters following a consistent age-metallicity relation can be associated to Gaia-Enceladus on the basis of their orbits. With an estimated 4:1 mass-ratio, the merger with Gaia-Enceladus must have led to the dynamical heating of the precursor of the Galactic thick disk and therefore contributed to the formation of this component approximately 10 Gyr ago. These findings are in line with simulations of galaxy formation, which predict that the inner stellar halo should be dominated by debris from just a few massive progenitors.Comment: 19 pages, 8 figures. Published in Nature in the issue of Nov. 1st, 2018. This is the authors' version before final edit