Integrating Comprehensive Geriatric Assessment for people with COPD and frailty starting pulmonary rehabilitation: the Breathe Plus feasibility trial protocol.

One in five people with COPD also lives with frailty. People living with both COPD and frailty are at increased risk of poorer health and outcomes, and face challenges to completing pulmonary rehabilitation. Integrated approaches that are adapted to the additional context of frailty are required. The aim of the present study is to determine the feasibility of conducting a randomised controlled trial of an integrated Comprehensive Geriatric Assessment for people with COPD and frailty starting pulmonary rehabilitation. This is a multicentre, mixed-methods, assessor-blinded, randomised, parallel group, controlled feasibility trial ("Breathe Plus"; ISRCTN13051922). We aim to recruit 60 people aged ≥50 with both COPD and frailty referred for pulmonary rehabilitation. Participants will be randomised 1:1 to receive usual pulmonary rehabilitation, or pulmonary rehabilitation with an additional Comprehensive Geriatric Assessment. Outcomes (physical, psycho-social and service use) will be measured at baseline, 90 days and 180 days. We will also collect service and trial process data, and conduct qualitative interviews with a sub-group of participants and staff. We will undertake descriptive analysis of quantitative feasibility outcomes (recruitment, retention, missing data, blinding, contamination, fidelity), and framework analysis of qualitative feasibility outcomes (intervention acceptability and theory, outcome acceptability). Recommendations on progression to a full trial will comprise integration of quantitative and qualitative data, with input from relevant stakeholders. This study has been approved by a UK Research Ethics Committee (ref.: 19/LO/1402). This protocol describes the first study testing the feasibility of integrating a Comprehensive Geriatric Assessment alongside pulmonary rehabilitation, and testing this intervention within a mixed-methods randomised controlled trial

Built-in and induced polarization across LaAlO3_3/SrTiO3_3 heterojunctions

Ionic crystals terminated at oppositely charged polar surfaces are inherently unstable and expected to undergo surface reconstructions to maintain electrostatic stability. Essentially, an electric field that arises between oppositely charged atomic planes gives rise to a built-in potential that diverges with thickness. In ultra thin film form however the polar crystals are expected to remain stable without necessitating surface reconstructions, yet the built-in potential has eluded observation. Here we present evidence of a built-in potential across polar \lao ~thin films grown on \sto ~substrates, a system well known for the electron gas that forms at the interface. By performing electron tunneling measurements between the electron gas and a metallic gate on \lao ~we measure a built-in electric field across \lao ~of 93 meV/\AA. Additionally, capacitance measurements reveal the presence of an induced dipole moment near the interface in \sto, illuminating a unique property of \sto ~substrates. We forsee use of the ionic built-in potential as an additional tuning parameter in both existing and novel device architectures, especially as atomic control of oxide interfaces gains widespread momentum.Comment: 6 pages, 4 figures. Submitted to Nature physics on May 1st, 201

First-principles study of a tilt grain-boundary in rutile

[[abstract]]The atomic and electronic structure of a tilt grain boundary in rutile TiO2 has been calculated in an ab initio manner. The method employs a plane-wave basis set and optimized pseudopotentials and is carried out within the local-density approximation of density-functional theory. The study focuses on the structure and energy of the ∑=15 36.9° (210)[001] tilt boundary, which is relaxed to equilibrium using a conjugate gradients iterative minimization technique. The calculations confirm the stability of a proposed atomic model for the boundary and provide some insight into its electronic structure.[[incitationindex]]SCI[[booktype]]紙本[[booktype]]電子

Ultrastructure of Deinopis egg sac (Araneae: Deinopidae)

Attacks by predators and parasitoids on spider eggs are common. To counteract their negative effect, spiders have evolved a series of behaviours and features related to their egg sacs. In the genus Deinopis (Deinopidae) the tightly woven external layer of the egg sac seems to be an effective barrier. This layer consists of two sub-layers: the outer sub-layer is constructed of thin threads densely woven with an apparently hardened liquid that cements the threads together, and an inner sub-layer that seems to be even more compact and in which threads are not discernible. Threads of the external layer are presumably produced by the cylindrical glands, but other glands may be involved in production of the liquid substance.UCR::Vicerrectoría de Docencia::Ciencias Básicas::Facultad de Ciencias::Escuela de Biologí

Bird-spiders (Arachnida, Mygalomorphae) as perceived by the inhabitants of the village of Pedra Branca, Bahia State, Brazil

This paper deals with the conceptions, knowledge and attitudes of the inhabitants of the county of Pedra Branca, Bahia State, on mygalomorph spiders locally known as 'caranguejeiras' (bird-spiders). It is launched here a new filed within ethnozoology: ethnoarachnology, which is defined as the transdisciplinary study of the relationships between human beings and bird-spiders. Data were collected from February to June 2005 by means of open-ended interviews carried out with 30 individuals, which ages ranged from 13 to 86 years old. It was recorded some traditional knowledge regarding the following items: taxonomy, biology, habitat, ecology, seasonality, and behavior. Results show that bird-spiders are classified as "insects". The most commented aspect of the interaction between bird-spiders and inhabitants of Pedra Branca is related to their dangerousness, since they said these spiders are very venomous and can cause health problems. In general, the traditional zoological knowledge of Pedra Branca's inhabitants concerning these spiders is coherent with the academic knowledge

Incidence of parasitoids and predators on eggs of seven species of Therididae (Araneae)

Although many characteristics of the egg sacs of spiders likely evolved to reduce the effect of parasites and predators that attack their eggs, many parasite and predator insects have become specialized on spider eggs. Eggs of six of the seven species of Theridiidae included in this study were attacked by wasp parasites (Baeus achaearaneus, Idris sp., and Comastichus zopheros), and two by the specialized spider egg predator (Neuroptera: Zeugomantispa minuta). The incidence of parasites in the egg sacs varied across species. Parasites attacked more than 60% of the egg sacs of Tidarren sisyphoides and Parasteatoda tepidariorum, but none of the sacs of Latrodectus geometricus. The incidence of parasites in the egg sacs was higher during the dry season for T. sisyphoides, and during the rainy season for P. tepidariorum. The proportion of the eggs parasitized per egg sac varied from 0.09 (± 0.19) in Nesticodes rufipes to 0.50 (± 0.46) in T. sisyphoides. Differences in the biology of parasites, as well as in the structure of spider webs and hábitat preference of spiders, may influence the incidence of parasitism and proportion of eggs parasitized in each egg sac.Vicerrectoría de InvestigaciónUCR::Vicerrectoría de Docencia::Ciencias Básicas::Facultad de Ciencias::Escuela de Biologí

Positive outcomes: validity, reliability and responsiveness of a novel person-centred outcome measure for people with HIV

Objectives Despite successful treatment, people living with HIV experience persisting and burdensome multidimensional problems. We aimed to assess the validity, reliability and responsiveness of Positive Outcomes, a patient-reported outcome measure for use in clinical practice. Methods In all, 1392 outpatients in five European countries self-completed Positive Outcomes, PAM-13 (patient empowerment), PROQOL-HIV (quality of life) and FRAIL (frailty) at baseline and 12 months. Analysis assessed: (a) validity (structural, convergent and divergent, discriminant); (b) reliability (internal consistency, test-retest); and (c) responsiveness. Results An interpretable four-factor structure was identified: ‘emotional wellbeing’, ‘interpersonal and sexual wellbeing’, ‘socioeconomic wellbeing’ and ‘physical wellbeing’. Moderate to strong convergent validity was found for three subscales of Positive Outcomes and PROQOL (ρ = −0.481 to −0.618, all p < 0.001). Divergent validity was found for total scores with weak ρ (−0.295, p < 0.001). Discriminant validity was confirmed with worse Positive Outcomes score associated with increasing odds of worse FRAIL group (4.81-fold, p < 0.001) and PAM-13 level (2.28-fold, p < 0.001). Internal consistency for total Positive Outcomes and its factors exceeded the conservative α threshold of 0.6. Test-retest reliability was established: those with stable PAM-13 and FRAIL scores also reported median Positive Outcomes change of 0. Improved PROQOL-HIV score baseline to 12 months was associated with improved Positive Outcomes score (r = −0.44, p < 0.001). Conclusions Positive Outcomes face and content validity was previously established, and the remaining validity, reliability and responsiveness properties are now demonstrated. The items within the brief 22-item tool are designed to be actionable by health and social care professionals to facilitate the goal of person-centred care

Superstripes and complexity in high-temperature superconductors

While for many years the lattice, electronic and magnetic complexity of high-temperature superconductors (HTS) has been considered responsible for hindering the search of the mechanism of HTS now the complexity of HTS is proposed to be essential for the quantum mechanism raising the superconducting critical temperature. The complexity is shown by the lattice heterogeneous architecture: a) heterostructures at atomic limit; b) electronic heterogeneity: multiple components in the normal phase; c) superconducting heterogeneity: multiple superconducting gaps in different points of the real space and of the momentum space. The complex phase separation forms an unconventional granular superconductor in a landscape of nanoscale superconducting striped droplets which is called the "superstripes" scenario. The interplay and competition between magnetic orbital charge and lattice fluctuations seems to be essential for the quantum mechanism that suppresses thermal decoherence effects at an optimum inhomogeneity.Comment: 20 pages, 3 figures; J. Supercon. Nov. Mag. 201