Patient and family member experiences of involvement in critical care research and quality improvement projects

Background: Public and patient involvement in healthcare research is increasing, but the impact of involvement on the individuals, on service delivery and on health outcomes, particularly in specialist population groups like critical care, remains unclear, as does the best way to involve people who have experienced critical illness. Objectives: To explore former patients’ and family members’ views and experiences of involvement in critical care research and/or quality improvement. Methods: Using a qualitative methodology, semi-structured telephone interviews were conducted with seven former intensive care unit patients and three close family members, across England. Data were analyzed using a standard process of inductive thematic analysis. Results: Four key themes were identified: making it happen; overcoming hurdles; it helps; respect and value. Findings centre on the need for flexibility, inclusivity and transparency. They further highlight the particular challenges faced by critical illness survivors and their family members in relation to research involvement, the importance of individualised support and training and the vital role that project leads have in making people feel valued and equal partners in the process Discussion: This is the first study to explore patients’ experiences of involvement in critical care research. Despite the small, homogenous sample, the study provides valuable and important data, to guide future practice. It highlights the need to enable and support people to make informed choices at a time when they are ready to do so. It further highlights the importance of gatekeepers, to avoid vulnerable people contributing before they are ready, a practice, which could negatively affect their heath status

Dark Matter and Pseudo-flat Directions in Weakly Coupled SUSY Breaking Sectors

We consider candidates for dark matter in models of gauge mediated supersymmetry breaking, in which the supersymmetry breaking sector is weakly coupled and calculable. Such models typically contain classically flat directions, that receive one-loop masses of a few TeV. These pseudo-flat directions provide a new mechanism to account for the cold dark matter relic abundance. We discuss also the possibility of heavy gravitino dark matter in such models.Comment: 16 pages, 2 figures. v2: comments, refs adde

Supersymmetric sound in fluids

We consider the hydrodynamics of supersymmetric fluids. Supersymmetry is broken spontaneously and the low energy spectrum includes a fermionic massless mode, the $\mathit{phonino}$. We use two complementary approaches to describe the system: First, we construct a generating functional from which we derive the equations of motion of the fluid and of the phonino propagating through the fluid. We write the form of the leading corrections in the derivative expansion, and show that the so called diffusion terms in the supercurrent are in fact not dissipative. Second, we use an effective field theory approach which utilizes a non-linear realization of supersymmetry to analyze the interactions between phoninos and phonons, and demonstrate the conservation of entropy in ideal fluids. We comment on possible phenomenological consequences for gravitino physics in the early universe.Comment: Modified introduction and discussion of diffusion terms in the supercurren

Narrowly distributed crystal orientation in biomineral vaterite

Biominerals formed by animals provide skeletal support, and many other functions. They were previously shown to grow by aggregation of amorphous nanoparticles, but never to grow ion-by-ion from solution, which is a common growth mechanism for abiotic crystals. We analyze vaterite CaCO3 multi crystalline spicules from the solitary tunicate Herdmania momus, with Polarization dependent Imaging Contrast PIC mapping, scanning and aberration corrected transmission electron microscopies. The first fully quantitative PIC mapping data, presented here, measured 0{\deg} 30{\deg} angle spreads between immediately adjacent crystals. Such narrowly distributed crystal orientations demonstrate that crystallinity does not propagate from one crystal to another 0{\deg} angle spreads, nor that new crystals with random orientation 90{\deg} nucleate. There are no organic layers at the interface between crystals, hence a new, unknown growth mechanism must be invoked, with crystal nucleation constrained within 30{\deg}. Two observations are consistent with crystal growth from solution: vaterite microcrystals express crystal faces, and are smooth at the nanoscale after cryo fracture. The observation of 30{\deg} angle spreads, lack of interfacial organic layers, and smooth fracture figures broadens the range of known biomineralization mechanisms and may inspire novel synthetic crystal growth strategies. Spherulitic growth from solution is one possible mechanism consistent with all these observations.Comment: Chemistry of Materials 201

ASASSN-15pz: Revealing Significant Photometric Diversity among 2009dc-like, Peculiar SNe Ia

We report comprehensive multi-wavelength observations of a peculiar Type Ia-like supernova ("SN Ia-pec") ASASSN-15pz. ASASSN-15pz is a spectroscopic "twin" of SN 2009dc, a so-called "Super-Chandrasekhar-mass" SN, throughout its evolution, but it has a peak luminosity M_B,peak = -19.69 +/- 0.12 mag that is \approx 0.6 mag dimmer and comparable to the SN 1991T sub-class of SNe Ia at the luminous end of the normal width-luminosity relation. The synthesized Ni56 mass of M_Ni56 = 1.13 +/- 0.14 M_sun is also substantially less than that found for several 2009dc-like SNe. Previous well-studied 2009dc-like SNe have generally suffered from large and uncertain amounts of host-galaxy extinction, which is negligible for ASASSN-15pz. Based on the color of ASASSN-15pz, we estimate a host extinction for SN 2009dc of E(B-V)_host=0.12 mag and confirm its high luminosity (M_B, peak[2009dc] \approx -20.3 mag). The 2009dc-like SN population, which represents ~1% of SNe Ia, exhibits a range of peak luminosities, and do not fit onto the tight width-luminosity relation. Their optical light curves also show significant diversity of late-time (>~ 50 days) decline rates. The nebular-phase spectra provide powerful diagnostics to identify the 2009dc-like events as a distinct class of SNe Ia. We suggest referring to these sources using the phenomenology-based "2009dc-like SN Ia-pec" instead of "Super-Chandrasekhar SN Ia," which is based on an uncertain theoretical interpretation.Comment: 21 pages, 16 figures, accepted for publication in Ap

A Significantly off-center Ni56 Distribution for the Low-Luminosity Type Ia Supernova SN 2016brx from the 100IAS survey

We present nebular-phase spectra of the Type Ia supernova (SN Ia) 2016brx, a member of the 1991bg-like subclass that lies at the faint end of the SN Ia luminosity function. Nebular spectra are available for only three other 1991bg-like SNe, and their Co line centers are all within <~ 500 km/s of each other. In contrast, the nebular Co line center of SN 2016brx is blue-shifted by >1500 km/s compared to them and by ~1200 km/s compared to the rest frame. This is a significant shift relative to the narrow nebular line velocity dispersion of <~ 2000 km/s of these SNe. The large range of nebular line shifts implies that the Ni56 in the ejecta of SN 1991bg-like events is off-center by ~1000 km/s rather than universally centrally confined as previously suggested. With the addition of SN 2016brx, the Co nebular line shapes of 1991bg-like objects appear to connect with the brighter SNe Ia that show double-peak profiles, hinting at a continuous distribution of line profiles among SNe Ia. One class of models to produce both off-center and bi-modal Ni56 distributions is collisions of white dwarfs with unequal and equal masses.Comment: Minor Changes. Accepted by MNRAS Lette

Dynamic Control of Nanoprecipitation in a Nanopipette

Studying the earliest stages of precipitation at the nanoscale is technically challenging but quite valuable as such phenomena reflect important processes such as crystallization and biomineralization. Using a quartz nanopipette as a nanoreactor, we induced precipitation of an insoluble salt to generate oscillating current blockades. The reversible process can be used to measure both kinetics of precipitation and relative size of the resulting nanoparticles. Counter ions for the highly water-insoluble salt zinc phosphate were separated by the pore of a nanopipette and a potential applied to cause ion migration to the interface. By analyzing the kinetics of pore blockage, two distinct mechanisms were identified: a slower process due to precipitation from solution, and a faster process attributed to voltage-driven migration of a trapped precipitate. We discuss the potential of these techniques in studying precipitation dynamics, trapping particles within a nanoreactor, and electrical sensors based on nanoprecipitation

Phase 1 Safety and Immunogenicity Evaluation of ADVAX, a Multigenic, DNA-Based Clade C/B' HIV-1 Candidate Vaccine

BACKGROUND: We conducted a Phase I dose escalation trial of ADVAX, a DNA-based candidate HIV-1 vaccine expressing Clade C/B' env, gag, pol, nef, and tat genes. Sequences were derived from a prevalent circulating recombinant form in Yunnan, China, an area of high HIV-1 incidence. The objective was to evaluate the safety and immunogenicity of ADVAX in human volunteers. METHODOLOGY/PRINCIPAL FINDINGS: ADVAX or placebo was administered intramuscularly at months 0, 1 and 3 to 45 healthy volunteers not at high risk for HIV-1. Three dosage levels [0.2 mg (low), 1.0 mg (mid), and 4.0 mg (high)] were tested. Twelve volunteers in each dosage group were assigned to receive ADVAX and three to receive placebo in a double-blind design. Subjects were followed for local and systemic reactogenicity, adverse events, and clinical laboratory parameters. Study follow up was 18 months. Humoral immunogenicity was evaluated by anti-gp120 binding ELISA. Cellular immunogenicity was assessed by a validated IFNgamma ELISpot assay and intracellular cytokine staining. ADVAX was safe and well-tolerated, with no vaccine-related serious adverse events. Local and systemic reactogenicity events were reported by 64% and 42% of vaccine recipients, respectively. The majority of events were mild. The IFNgamma ELISpot response rates to any HIV antigen were 0/9 (0%) in the placebo group, 3/12 (25%) in the low-dosage group, 4/12 (33%) in the mid-dosage group, and 2/12 (17%) in the high-dosage group. Overall, responses were generally transient and occurred to each gene product, although volunteers responded to single antigens only. Binding antibodies to gp120 were not detected in any volunteers, and HIV seroconversion did not occur. CONCLUSIONS/SIGNIFICANCE: ADVAX delivered intramuscularly is safe, well-tolerated, and elicits modest but transient cellular immune responses. TRIAL REGISTRATION: Clinicaltrials.gov NCT00249106.published_or_final_versio