The trajectory to diagnosis with pulmonary arterial hypertension: a qualitative study

Objectives To investigate the patient's experience of the trajectory to receiving a diagnosis of pulmonary arterial hypertension (PAH) and inform the provision of care for this patient group. Design Qualitative study using in-depth one-to-one interviews and pictorial representations. Data were analysed using thematic analysis. Setting Participants were interviewed in their own homes across England. Participants 30 patients with a diagnosis of pulmonary hypertension (18 participants were women, mean age 56 and range 26-80 02years and time since diagnosis ranged from a few months to more than 12 02years) participated. Results All participants, regardless of the time since diagnosis, vividly described the process from manifestation of symptoms to receiving a confirmed diagnosis. The authors present data using three major themes: (i) making sense of symptoms, (ii) process of elimination and (iii) being diagnosed with PAH. Making sense of symptoms represented an early period of perseverance 14people tried to carry-on as usual despite 18unexplained breathlessness 19. As time progressed, this period was punctuated by critical events that triggered seeking medical advice. Once medical contact had been made, patients described a period of 18elimination 19 and convoluted contact with the medical profession. Dyspnoea misdiagnosis was a key factor that delayed the PAH diagnosis. Diagnosis disclosure by some medical professionals was also viewed as lacking empathy. More positive experiences were relayed when the medical team disclosing the diagnosis acknowledged previous limitations. Conclusions A lack of awareness of this illness from both the sufferer themselves and the medical profession emerged as a central theme and led to prolonged periods of being misdiagnosed. The application of a diagnostic pathway for unexplained dyspnoea that alerts practitioners to rare conditions could expedite the process of correct diagnosis

Ni-Pt-Ge-Rich Fremdlinge; indicators of a turbulent early solar nebula

One of the oddest aspects of CAis is the presence of Fremdlinge-complex aggregates of refractory metal alloys and volatile oxides and sulfides. In a series of recent studies of Fremdlinge we have provided evidence that (I) they are not isotopically anomalous and presumably formed in the solar nebula, (2) they were formed as solid objects before any of the major phases in CAis, (3) processes involved in their formation , prior to incorporation in CAis. included oxidation and reduction both at high and low temperatures, and (4) their phase assemblages and reaction textures place strict constraints on the maximum temperatures and cooling rates during CAl formation (Armstrong et al., 1984, 1985a, 1985b; Hutcheon et al., 1985)

Role of Boron p-Electrons and Holes in Superconducting MgB2, and other Diborides: A Fully-Relaxed, Full-Potential Electronic Structure Study

We present the results of fully-relaxed, full-potential electronic structure calculations for the new superconductor MgB2, and BeB2, NaB2, and AlB2, using density-functional-based methods. Our results described in terms of (i) density of states (DOS), (ii) band-structure, and (iii) the DOS and the charge density around the Fermi energy EF, clearly show the importance of B p-band for superconductivity. In particular, we show that around EF, the charge density in MgB2, BeB2 and NaB2 is planar and is associated with the B plane. For BeB2 and NaB2, our results indicate qualitative similarities but significant quantitative differences in their electronic structure due to different lattice constants a and c.Comment: 4 pages, 4 figures, Submitted to Phys Rev. Lett. on March 6, 2001; resubmission on April 2

Fremdlinge in Leoville and Allende CAI – Clues to Post-Formation Cooling and Alteration

Fremdlinge are perhaps the most exotic and least understood objects in CAI and their very existence places severe constraints regarding formation and cooling histories of the host CAI. Following the discovery and description of Willy, which appears to be an "Ur-Fremdling" or prototype for smaller Fremdlinge in CAI, we have begun a systematic study of CAI of different petrographic types to see if the Fremdlinge are consistent with a common mode of formation and differing degrees of reprocessing. Fifteen type B I, B2, and compact A CAI from Allende and Leoville were selected. The relative abundance of Fremdlinge varies dramatically among CAI, however some CAI of each type and from each meteorite contain abundant Fremdlinge. The range of phase assemblages and mineral chemistries of Fremdlinge from Allende and Leoville is very similar suggesting that the parent sources for Fremdlinge were quite similar. Chemically and texturally, Fremdlinge grade continuously from complex, heterogeneous Willy-like objects to altered, homogeneous metal nuggets. Some complex Fremdlinge like Willy were found in B1 CAI; none were observed in B2 CAI

Mg Isotopic studies of Leoville "compact" type a CAI

One long-standing problem in the application of Al-Mg isotopic systematics to the chronology of CAI is the enigmatic Mg isotopic record of hibonite. Hibonite (ideally, CaAI_(12)O_(19)) is one of the first major element bearing phases to appear in the condensation sequence [1] and occurs as a major constituent only in CAI whose bulk composition is considerably more refractory than Allende Type Bl CAI

Impaired interferon-γ responses, increased interleukin-17 expression, and a tumor necrosis factor–α transcriptional program in invasive aspergillosis

This article is available open access through the publisher’s website. Copyright @ 2009 Oxford University Press.Background - Invasive aspergillosis (IA) is the most common cause of death associated with fungal infection in the developed world. Historically, susceptibility to IA has been associated with prolonged neutropenia; however, IA has now become a major problem in patients on calcineurin inhibitors and allogenic hematopoetic stem cell transplant patients following engraftment. These observations suggest complex cellular mechanisms govern immunity to IA. Methods - To characterize the key early events that govern outcome from infection with Aspergillus fumigatus we performed a comparative immunochip microarray analysis of the pulmonary transcriptional response to IA between cyclophosphamide-treated mice and immunocompetent mice at 24 h after infection. Results - We demonstrate that death due to infection is associated with a failure to generate an incremental interferon-γ response, increased levels of interleukin-5 and interleukin-17a transcript, coordinated expression of a network of tumor necrosis factor–α-related genes, and increased levels of tumor necrosis factor–α. In contrast, clearance of infection is associated with increased expression of a number genes encoding proteins involved in innate pathogen clearance, as well as apoptosis and control of inflammation. Conclusion - This first organ-level immune response transcriptional analysis for IA has enabled us to gain new insights into the mechanisms that govern fungal immunity in the lung.The BBSRC, CGD Research Trust, and the MRC

The Cr Isotopic Composition of Phosphates in IIIB Iron Meteorites: A Search for ^(53)Mn

The metal phases of iron meteorites contain excess ^(107) Ag most plausibly derived from the in situ decay of ^(107)Pd (T_(1/2) = 6.5 x 10^6y) (Kaiser and Wasserburg, 1983; Chen and Wasserburg, 1983). The Ag isotopic data suggest that diverse types of iron meteorites, including the Type IIIABs, usually associated with fractional crystallization and core formation in planetesimals, formed and cooled to - 600°C within - 10^7y of ^(107)Pd production

Unusually large polarizabilities and "new" atomic states in Ba

Electric polarizabilities of four low-J even-parity states and three low-J odd-parity states of atomic barium in the range $35,600$ to $36,000\ $cm$^{-1}$are investigated. The states of interest are excited (in an atomic beam) via an intermediate odd-parity state with a sequence of two laser pulses. The odd-parity states can be excited due to the Stark-induced mixing with even-parity states. The polarizabilities are measured via direct spectroscopy on the second-stage transition. Several states have tensor and scalar polarizabilities that exceed the values that might be expected from the known energy levels of barium by more than two orders of magnitude. Two of the Stark-induced transitions cannot be identified from the known energy spectrum of barium. The observations suggest the existence of as yet unidentified odd-parity energy states, whose energies and angular momenta are determined in the present experiment. A tentative identification of these states as [Xe]$6s8p ^3P_{0,2}$ is suggested.Comment: 29 pages, 12 figure

Measurement of swelling-induced residual stress in ion implanted SiC, and its effect on micromechanical properties

Ion implantation is widely used as a surrogate for neutron irradiation in the investigation of radiation damage on the properties of materials. Due to the small depth of damage, micromechanical methods must be used to extract material properties. In this work, nanoindentation has been applied to ion irradiated silicon carbide to extract radiation-induced hardening. Residual stress is evaluated using HR-EBSD, AFM swelling measurements, and a novel microcantilever relaxation technique coupled with finite element modelling. Large compressive residual stresses of several GPa are found in the irradiated material, which contribute to the significant hardening observed in nanoindentation measurements. The origin of these residual stresses and the associated hardening is the unirradiated substrate which constrains radiation swelling. Comparisons with other materials susceptible to irradiation swelling show that this effect should not be neglected in studying the effects of ion irradiation damage on mechanical properties. This constraint may also be influencing fundamental radiation defects. This has significant implications for the suitability of ion implantation as a surrogate for neutron irradiations. These results demonstrate the significance of swelling-induced residual stresses in nuclear reactor components, and the impact on structural integrity of reactor components.Comment: 23 pages, 7 figure