An Exploration of the Help-Seeking Experiences of Patients in an Allied Professions-Led Rapid Access Chest Pain Pathway – A Qualitative Study

Objective: A number of studies have explored delayed help-seeking practices for acute coronary syndrome (ACS) and have cited multiple intersecting factors which may play a role (e.g. attributing symptoms, age, gender, ethnicity and contextual influences). However, the pathway to diagnosis for suspected Coronary Heart Disease (CHD) symptoms in a Rapid Acess Chest Pain Clinic (RACPC) context is underexplored. The objective of this study was to explore patients’ help-seeking experiences of accessing RACPC services: from the point at which they notice and interpret symptoms to their decision to seek help from their GP, attend a RACPC, and receive a diagnosis Design: Qualitative study Setting: Interviews were conducted in RACPC at Queen Mary’s Roehampton Hospital, London, United Kingdom Participants: Maximium Variation sampling was used to recruit 30 participants referred to a RACPC, including 15 men and 15 women utilising sampling dimensions of age, ethnicity and occupation. Methods: Semi-structured interviews that focused on the patient experience of their pathway to diagnosis in RACPC. Thematic analysis was used to interpret the interview data. Results: The interpretation of symptoms was shaped by multiple factors; reluctance to seek help contributed to delay; with various factors acting as drivers as well as barriers to help-seeking; and referrals to RACPC were based on symptoms as well as patient need reassurance. Conclusion: We found complex issues shaped the patient decision-making when accessing the RACPC, including making sense of symptoms and help-seeking practices. These findings can be used to develop health promotion literature to encourage early help-seeking and improve of RACPC services

The COMPLETE Nature of the Warm Dust Ring in Perseus

The Perseus molecular cloud complex is a ~30pc long chain of molecular clouds most well-known for the two star-forming clusters NGC1333 and IC348 and the well-studied outflow source in B5. However, when studied at mid- to far-infrared wavelengths the region is dominated by a ~10pc diameter shell of warm dust, likely generated by an HII region caused by the early B-star HD278942. Using a revised calibration technique the COMPLETE team has produced high-sensitivity temperature and column-density maps of the Perseus region from IRAS Sky Survey Atlas (ISSA) 60 and 100um data. In this paper, we combine the ISSA based dust-emission maps with other observations collected as part of the COMPLETE Survey, along with archival H-alpha and MSX observations. Molecular line observations from FCRAO and extinction maps constructed by applying the NICER method to the 2MASS catalog provide independent estimates of the ``true'' column-density of the shell. H-alpha emission in the region of the shell confirms that it is most likely an HII region located behind the cloud complex, and 8um data from MSX indicates that the shell may be interacting with the cloud. Finally, the two polarisation components previously seen towards background stars in the region can be explained by the association of the stronger component with the shell. If confirmed, this would be the first observation of a parsec-scale swept-up magnetic field.Comment: Accepted by ApJ. Figures have been compressed - full resolution version available at http://cfa-www.harvard.edu/COMPLETE/results.htm

Human GUCY2C-Targeted Chimeric Antigen Receptor (CAR)-Expressing T Cells Eliminate Colorectal Cancer Metastases.

One major hurdle to the success of adoptive T-cell therapy is the identification of antigens that permit effective targeting of tumors in the absence of toxicities to essential organs. Previous work has demonstrated that T cells engineered to express chimeric antigen receptors (CAR-T cells) targeting the murine homolog of the colorectal cancer antigen GUCY2C treat established colorectal cancer metastases, without toxicity to the normal GUCY2C-expressing intestinal epithelium, reflecting structural compartmentalization of endogenous GUCY2C to apical membranes comprising the intestinal lumen. Here, we examined the utility of a human-specific, GUCY2C-directed single-chain variable fragment as the basis for a CAR construct targeting human GUCY2C-expressing metastases. Human GUCY2C-targeted murine CAR-T cells promoted antigen-dependent T-cell activation quantified by activation marker upregulation, cytokine production, and killing of GUCY2C-expressing, but not GUCY2C-deficient, cancer cells in vitro. GUCY2C CAR-T cells provided long-term protection against lung metastases of murine colorectal cancer cells engineered to express human GUCY2C in a syngeneic mouse model. GUCY2C murine CAR-T cells recognized and killed human colorectal cancer cells endogenously expressing GUCY2C, providing durable survival in a human xenograft model in immunodeficient mice. Thus, we have identified a human GUCY2C-specific CAR-T cell therapy approach that may be developed for the treatment of GUCY2C-expressing metastatic colorectal cancer

The Mass-Size Relation from Clouds to Cores. I. A new Probe of Structure in Molecular Clouds

We use a new contour-based map analysis technique to measure the mass and size of molecular cloud fragments continuously over a wide range of spatial scales (0.05 < r / pc < 10), i.e., from the scale of dense cores to those of entire clouds. The present paper presents the method via a detailed exploration of the Perseus Molecular Cloud. Dust extinction and emission data are combined to yield reliable scale-dependent measurements of mass. This scale-independent analysis approach is useful for several reasons. First, it provides a more comprehensive characterization of a map (i.e., not biased towards a particular spatial scale). Such a lack of bias is extremely useful for the joint analysis of many data sets taken with different spatial resolution. This includes comparisons between different cloud complexes. Second, the multi-scale mass-size data constitutes a unique resource to derive slopes of mass-size laws (via power-law fits). Such slopes provide singular constraints on large-scale density gradients in clouds.Comment: accepted to ApJ; references updated in new versio

Turbulence driven by outflow-blown cavities in the molecular cloud of NGC 1333

Outflows from young stellar objects have been identified as a possible source of turbulence in molecular clouds. To investigate the relationship between outflows, cloud dynamics and turbulence, we compare the kinematics of the molecular gas associated with NGC 1333, traced in 13CO(1-0), with the distribution of young stellar objects (YSOs) within. We find a velocity dispersion of ~ 1-1.6 km/s in 13CO that does not significantly vary across the cloud, and is uncorrelated with the number of nearby young stellar outflows identified from optical and submillimeter observations. However, from velocity channel maps we identify about 20 cavities or depressions in the 13CO intensity of scales > 0.1-0.2 pc and velocity widths 1-3 km/s. The cavities exhibit limb brightened rims in both individual velocity channel maps and position velocity diagrams, suggesting that they are slowly expanding. We interpret these cavities to be remnants of past YSO outflow activity: If these cavities are presently empty, they would fill in on time scales of a million years. This can exceed the lifetime of a YSO outflow phase, or the transit time of the central star through the cavity, explaining the the absence of any clear correlation between the cavities and YSO outflows. We find that the momentum and energy deposition associated with the expansion of the cavities is sufficient to power the turbulence in the cloud. In this way we conclude that the cavities are an important intermediary step between the conversion of YSO outflow energy and momentum into cloud turbulent motions.Comment: Accepted for publication in ApJ. Check out http://astro.pas.rochester.edu/~aquillen/coolpics.html for channel map and PosVel movies of N133

Sex, drugs and superbugs: The rise of drug resistant STIs

Antimicrobial resistance (AMR) presents a swiftly advancing challenge to a wide range of healthcare and health promotion practices. While rising rates of AMR share some dimensions across contexts, the specificities of field, practice, place and population shape – and at times hinder attempts to stem – the rising tide of this health threat. Sexually transmitted infections (STIs) are one area of healthcare where the threat of AMR has traditionally been met with lethargy. In this paper, we draw on a range of stakeholder perspectives across practice, innovation and regulatory systems in Australia, the US and the UK to understand and examine the evolving nexus of STIs and AMR, including the roles of cultural reception, professional practice and political traction. We argue for a critical sociology of the nexus of sexual health and evolving resistance, which will be instructive for comprehending inaction and informing future developments. We also note that part of this critical sociology must involve challenging stigma concerning sexual practices and people/groups, and recognising the role of communities in driving positive change

An Expanding HI Photodissociated Region Associated with the Compact HII Region G213.880-11.837 in the GGD 14 Complex

We present high angular and spectral resolution HI 21~cm line observations toward the cometary-shaped compact HII region G213.880-11.837 in the GGD~14 complex.The kinematics and morphology of the photodissociated region, traced by the HI line emission, reveal that the neutral gas is part of an expanding flow. The kinematics of the HI gas along the major axis of G213.880-11.837 shows that the emission is very extended toward the SE direction, reaching LSR radial velocities in the tail of about 14 km/s. The ambient LSR radial velocity of the molecular gas is 11.5 km/s, which suggests a champagne flow of the HI gas. This is the second (after G111.61+0.37) cometary HII/HI region known.Comment: Accepted for publication in the Astronomical Journal (10 pages, 4 figures, 1 table

Exploring the lived experience of Long Covid in black and minority ethnic groups in the UK: Protocol for qualitative interviews and art-based methods

Some people experience prolonged symptoms following an acute COVID-19 infection including fatigue, chest pain and breathlessness, headache and cognitive impairment. When symptoms persist for over 12 weeks following the initial infection, and are not explained by an alternative diagnosis, the term post-COVID-19 syndrome is used, or the patient-defined term of Long Covid. Understanding the lived experiences of Long Covid is crucial to supporting its management. However, research on patient experiences of Long Covid is currently not ethnically diverse enough. The study aim is to explore the lived experience of Long Covid, using qualitative interviews and art-based methods, among people from ethnically diverse backgrounds (in the UK), to better understand wider systems of support and healthcare support needs. Co-created artwork will be used to build on the interview findings. A purposive sampling strategy will be used to gain diverse experiences of Long Covid, sampling by demographics, geographic locations and experiences of Long Covid. Individuals (aged >18 years) from Black and ethnic minority backgrounds, who self-report Long Covid symptoms, will be invited to take part in a semi-structured interview. Interviews will be analysed thematically. A sub-sample of participants will be invited to co-create visual artwork to further explore shared narratives of Long Covid, enhance storytelling and increase understanding about the condition. A patient advisory group, representing diversity in ethnicity and experiences of Long Covid, will inform all research stages. Stakeholder workshops with healthcare professionals and persons, systems or networks important to people’s management of Long Covid, will advise on the integration of findings to inform management of Long Covid. The study will use patient narratives from people from diverse ethnic backgrounds, to raise awareness of Long Covid and help inform management of Long Covid and how wider social systems and networks may inform better healthcare service access and experiences

Troubling meanings of "family" for young people who have been in care: from policy to lived experience

This article seeks to trouble the concept of “family” for young people who have been in out-of-home care, by reflecting on the continuing significance (and troubles) of family relationships beyond childhood. The analysis draws on two cross-national studies in Europe: Beyond Contact, which examined policies and systems for work with families of children in care, and Against All Odds?, a qualitative longitudinal study of young adults who have been in care. Policy discourses that reify and instrumentalize the concept of family—for example, through the language of “contact,” “reunification,” and “permanence”—neglect the complex temporality of “family” for young people who have been in care, negotiated and practiced across time and in multiple (and changing) care contexts, and forming part of complex, dynamic and relational identities, and understandings of “belonging” for young adults who have been in care