Improving Colorectal Cancer Screening Rates in Patients Referred to a Gastroenterology Clinic

Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related death in the United States. Colonoscopy and fecal immunochemistry testing (FIT) are the primary recommended CRC screening modalities. The purpose of this study is to improve rates of CRC screening in Veterans and County hospital patients referred to gastroenterology fellow's clinics. A total of 717 patients between ages of 49 and 75 years were seen. Previous CRC screening was not performed in 109 patients (15.2%) because of not being offered (73.4%) or declining (26.6%) screening. Patients who received previous CRC screening compared with no previous screening were older (mean age 62.3 years vs. 60.3 years, p < .003), white (88.6% vs. 78.3%, p < .027), and more likely to be Veterans patients (90.8% vs. 77.5%, p < .001). After systematically discussing options for screening with 78 of the 109 unscreened patients, 56 of them (71.8%) underwent screening with either colonoscopy (32) or FIT (24). Patients seen by fellows in their last year of training agreed to undergo screening more often than those seen by other fellows (100% vs. 66.2%, p < .033). Systematic discussions about both colonoscopy and FIT can improve the overall rates of CRC screening

Temperature dependence of antiferromagnetic order in the Hubbard model

We suggest a method for an approximative solution of the two dimensional Hubbard model close to half filling. It is based on partial bosonisation, supplemented by an investigation of the functional renormalisation group flow. The inclusion of both the fermionic and bosonic fluctuations leads in lowest order to agreement with the Hartree-Fock result or Schwinger-Dyson equation and cures the ambiguity of mean field theory . We compute the temperature dependence of the antiferromagnetic order parameter and the gap below the critical temperature. We argue that the Mermin-Wagner theorem is not practically applicable for the spontaneous breaking of the continuous spin symmetry in the antiferromagnetic state of the Hubbard model. The long distance behavior close to and below the critical temperature is governed by the renormalisation flow for the effective interactions of composite Goldstone bosons and deviates strongly from the Hartree-Fock result.Comment: New section on critical behavior 31 pages,17 figure

Design errors in vital sign charts used in consultant-led maternity units in the United Kingdom.

BACKGROUND: Paper-based charts remain the principal means of documenting the vital signs of hospitalised pregnant and postnatal women. However, poor chart design may contribute to both incorrect charting of data and clinical responses. We decided to identify design faults that might have an adverse clinical impact. METHODS: One hundred and twenty obstetric early warning charts and escalation protocols from consultant-led maternity units in the United Kingdom and the Channel Islands were analysed using an objective and systematic approach. We identified design errors that might impede their successful use (e.g. generate confusion regarding vital sign documentation, hamper the recognition of maternal deterioration, cause a failure of the early warning system or of any clinical response). RESULTS: We found 30% (n=36/120) of charts contained at least one design error with the potential to confuse staff, render the charts difficult to use or compromise patient safety. Amongst the most common areas were inadequate patient identification, poor use of colour, illogical weighting, poor alignment and labelling of axes, and the opportunity for staff to 'game' the escalation. CONCLUSIONS: We recommend the urgent development of an evidence-based, standardised obstetric observation chart, which integrates 'human factors' and user experience. It should have a clear layout and style, appropriate colour scheme, correct language and labelling, and the ability for vital signs to be documented accurately and quickly. It should incorporate a suitable early warning score to guide clinical management

Dynamics of pollen beetle (Brassicogethes aeneus) immigration and colonization of oilseed rape (Brassica napus) in Europe

BACKGROUND Understanding the dynamics of pest immigration into an agroecosystem enables effective and timely management strategies. The pollen beetle (Brassicogethes aeneus) is a primary pest of the inflorescence stages of oilseed rape (Brassica napus). This study investigated the spatial and temporal dynamics of pollen beetle immigration into oilseed rape fields in Denmark and the UK using multiple methods, including optical sensors. RESULTS In all fields, pollen beetles were found to be aggregated and beetle density was related to plant growth stage, with more beetles occurring on plants after the budding stage than before inflorescence development. Optical sensors were the most efficient monitoring method, recording pollen beetles 2 and 4 days ahead of water traps and counts from plant scouting, respectively. CONCLUSION Optical sensors are a promising tool for early warning of insect pest immigration. The aggregation pattern of pollen beetles post immigration could be used to precisely target control in oilseed rape crops. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry

Vital signs and other observations used to detect deterioration in pregnant women: an analysis of vital sign charts in consultant-led UK maternity units.

BACKGROUND: Obstetric early warning systems are recommended for monitoring hospitalised pregnant and postnatal women. We decided to compare: (i) vital sign values used to define physiological normality; (ii) symptoms and signs used to escalate care; (iii) type of chart used; and (iv) presence of explicit instructions for escalating care. METHODS: One hundred and twenty obstetric early warning charts and escalation protocols were obtained from consultant-led maternity units in the UK and Channel Islands. These data were extracted: values used to determine normality for each maternal vital sign; chart colour-coding; instructions following early warning system triggering; other criteria used as triggers. RESULTS: There was considerable variation in the charts, warning systems and escalation protocols. Of 120 charts, 89.2% used colour; 69.2% used colour-coded escalation systems. Forty-one (34.2%) systems required the calculation of weighted scores. Seventy-five discrete combinations of 'normal' vital sign ranges were found, the most common being: heart rate=50-99beats/min; respiratory rate=11-20breaths/min; blood pressure, systolic=100-149mmHg, diastolic ≤89mmHg; SpO2=95-100%; temperature=36.0-37.9°C; and Alert-Voice-Pain-Unresponsive assessment=Alert. Most charts (90.8%) provided instructions about who to contact following triggering, but only 41.7% gave instructions about subsequent observation frequency. CONCLUSION: The wide range of 'normal' vital sign values in different systems suggests a lack of equity in the processes for detecting deterioration and escalating care in hospitalised pregnant and postnatal women. Agreement regarding 'normal' vital sign ranges is urgently required and would assist the development of a standardised obstetric early warning system and chart

A qualitative study of the experiences and expectations of women receiving in-patient postnatal care in one English maternity unit

Background Studies consistently highlight in-patient postnatal care as the area of maternity care women are least satisfied with. As part of a quality improvement study to promote a continuum of care from the birthing room to discharge home from hospital, we explored women’s expectations and experiences of current inpatient care. Methods For this part of the study, qualitative data from semi-structured interviews were transcribed and analysed using content analyses to identify issues and concepts. Women were recruited from two postnatal wards in one large maternity unit in the South of England, with around 6,000 births a year. Results Twenty women, who had a vaginal or caesarean birth, were interviewed on the postnatal ward. Identified themes included; the impact of the ward environment; the impact of the attitude of staff; quality and level of support for breastfeeding; unmet information needs; and women’s low expectations of hospital based postnatal care. Findings informed revision to the content and planning of in-patient postnatal care, results of which will be reported elsewhere. Conclusions Women’s responses highlighted several areas where changes could be implemented. Staff should be aware that how they inter-act with women could make a difference to care as a positive or negative experience. The lack of support and inconsistent advice on breastfeeding highlights that units need to consider how individual staff communicate information to women. Units need to address how and when information on practical aspects of infant care is provided if women and their partners are to feel confident on the woman’s transfer home from hospital

Repetitive negative thinking and interpretation bias in pregnancy

Background: Repetitive negative thinking (RNT; e.g., worry about the future, rumination about the past) and the tendency to interpret ambiguous information in negative ways (interpretation bias) are cognitive processes that play a maintaining role in anxiety and depression, and recent evidence has demonstrated that interpretation bias maintains RNT. In the context of perinatal mental health, RNT has received minimal research attention (despite the fact that it predicts later anxiety and depression), and interpretation bias remains unstudied (despite evidence that it maintains depression and anxiety which are common in this period). Method: We investigated the relationship between RNT, interpretation bias and psychopathology (depression, anxiety) in a pregnant sample (n = 133). We also recruited an age-matched sample of non-pregnant women (n = 104), to examine whether interpretation bias associated with RNT emerges for ambiguous stimuli regardless of its current personal relevance (i.e., pregnancy or non-pregnancy-related). Results: As predicted, for pregnant women, negative interpretation bias, RNT, depression and anxiety were all positively associated. Interpretation bias was evident to the same degree for material that was salient (pregnancy-related) and non-salient (general), and pregnant and non-pregnant women did not differ. RNT was associated with interpretation bias for all stimuli and across the full sample. Conclusion: Our findings highlight the need to further investigate the impact of interpretation bias in pregnant women, and test the effectiveness of interventions which promote positive interpretations in reducing RNT in the perinatal period

Search for Solar Axions Produced in p(d,3He)Ap(d,\rm{^3He})A Reaction with Borexino Detector

A search for 5.5-MeV solar axions produced in the $p+d\rightarrow\rm{^3He}+A (5.5 \rm{MeV})$ reaction was performed using the Borexino detector. The Compton conversion of axions to photons, ${\rm A}+e\rightarrow e+\gamma$; the axio-electric effect, ${\rm A}+e+Z\rightarrow e+Z$; the decay of axions into two photons, ${\rm A}\rightarrow2\gamma$; and inverse Primakoff conversion on nuclei, ${\rm A}+Z\rightarrow\gamma+Z$, are considered. Model independent limits on axion-electron ($g_{Ae}$), axion-photon ($g_{A\gamma}$), and isovector axion-nucleon ($g_{3AN}$) couplings are obtained: $|g_{Ae}\times g_{3AN}| \leq 5.5\times 10^{-13}$ and $|g_{A\gamma}\times g_{3AN}| \leq 4.6\times 10^{-11} \rm{GeV}^{-1}$ at $m_A <$ 1 MeV (90% c.l.). These limits are 2-4 orders of magnitude stronger than those obtained in previous laboratory-based experiments using nuclear reactors and accelerators.Comment: 11 pages, 7 figures, submitted to Phys.Rev.

The prevalence of intragenic deletions in patients with idiopathic hypogonadotropic hypogonadism and Kallmann syndrome

Idiopathic hypogonadotropic hypogonadism (IHH) and Kallmann syndrome (KS) are clinically and genetically heterogeneous disorders caused by a deficiency of gonadotrophin-releasing hormone (GnRH). Mutations in three genes—KAL1, GNRHR and FGFR1—account for 15–20% of all causes of IHH/KS. Nearly all mutations are point mutations identified by traditional PCR-based DNA sequencing. The relatively new method of multiplex ligation-dependent probe amplification (MLPA) has been successful for detecting intragenic deletions in other genetic diseases. We hypothesized that MLPA would detect intragenic deletions in ∼15–20% of our cohort of IHH/KS patients. Fifty-four IHH/KS patients were studied for KAL1 deletions and 100 were studied for an autosomal panel of FGFR1, GNRH1, GNRHR, GPR54 and NELF gene deletions. Of all male and female subjects screened, 4/54 (7.4%) had KAL1 deletions. If only anosmic males were considered, 4/33 (12.1%) had KAL1 deletions. No deletions were identified in any of the autosomal genes in 100 IHH/KS patients. We believe this to be the first study to use MLPA to identify intragenic deletions in IHH/KS patients. Our results indicate ∼12% of KS males have KAL1 deletions, but intragenic deletions of the FGFR1, GNRH1, GNRHR, GPR54 and NELF genes are uncommon in IHH/KS

Recent Borexino results and prospects for the near future

The Borexino experiment, located in the Gran Sasso National Laboratory, is an organic liquid scintillator detector conceived for the real time spectroscopy of low energy solar neutrinos. The data taking campaign phase I (2007 - 2010) has allowed the first independent measurements of 7Be, 8B and pep fluxes as well as the first measurement of anti-neutrinos from the earth. After a purification of the scintillator, Borexino is now in phase II since 2011. We review here the recent results achieved during 2013, concerning the seasonal modulation in the 7Be signal, the study of cosmogenic backgrounds and the updated measurement of geo-neutrinos. We also review the upcoming measurements from phase II data (pp, pep, CNO) and the project SOX devoted to the study of sterile neutrinos via the use of a 51Cr neutrino source and a 144Ce-144Pr antineutrino source placed in close proximity of the active material.Comment: 8 pages, 11 figures. To be published as proceedings of Rencontres de Moriond EW 201