Clinical questions raised by providers in the care of older adults: a prospective observational study

pre-printObjective: To characterise clinical questions raised by providers in the care of complex older adults in order to guide the design of interventions that can help providers answer these questions. Materials and methods: To elicit clinical questions, we observed and audio recorded outpatient visits at three healthcare organisations. At the end of each appointment, providers were asked to identify clinical questions raised in the visit. Providers rated their questions based on their urgency, importance to the patient's care and difficulty in finding a useful answer to. Transcripts of the audio recordings were analysed to identify ageing-specific factors that may have contributed to the nature of the questions. Results: We observed 36 patient visits with 10 providers at the three study sites. Providers raised 70 clinical questions (median of 2 clinical questions per patient seen; range 0-12), pursued 50 (71%) and successfully answered 34 (68%) of the questions they pursued. Overall, 36 (51%) of providers' questions were not answered. Over one-third of the questions were about treatment alternatives and adverse effects. All but two clinical questions were motivated either directly or indirectly by issues related to ageing, such as the normal physiological changes of ageing and diseases with higher prevalence in the elderly. Conclusions: The frequency of clinical questions was higher than in previous studies conducted in general primary care patient populations. Clinical questions were predominantly influenced by ageing-related issues. We propose a series of recommendations that may be used to guide the design of solutions to help providers answer their clinical questions in the care of older adults

On effective electromagnetic parameters of artificial nanostructured magnetic materials

In this paper we discuss effective material parameter description of new nanostructures designed to perform as artificial magnetic materials for vis- ible light. Among these structures there are various split-ring resonators, dual-bar structures, fishnet layers and other geometries. Artificial magnetic response in these structures appears due to weak spatial dispersion effects, and it is important to study the conditions under which the magnetic re- sponse can be adequately measured with effective permeability tensor. On the examples of dual bars and split rings we show that this is possible only under some quite restrictive conditions. In the general case, more compli- cated constitutive relations with more effective material parameters need to be developed.Comment: 20 pages, 2 figure

First African Marine Mammal Colloquium, South Africa, May 2010

The African Marine Mammal Colloquium (AMMC) was initiated to provide a platform for increased collaboration and communication between researchers working on marine mammals in and around Africa. The first meeting of the AMMC was held at Kleinbaai, South Africa, in May 2010. Talks were presented by each of the 48 participants and a number of discussion groups were held. Several countries were represented but most presentations and discussions were centred on research within the host country. In all, 13 papers that were based on presentations at the AMMC were selected after peer-review to appear in a special issue of the African Journal of Marine Science. Its theme, ‘Conservation biology of marine mammals in the southern African subregion’, reflects both the geographical area represented in these papers and their common subject.http://www.tandfonline.com/loi/tams2

ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.Background Persistent tendon pain that impairs function has inconsistent medical terms that can influence choice of treatment.1 When a person is told they have tendinopathy by clinician A or tendinitis by clinician B, they might feel confused or be alarmed at receiving what they might perceive as two different diagnoses. This may lead to loss of confidence in their health professional and likely adds to uncertainty if they were to search for information about their condition. Clear and uniform terminology also assists inter-professional communication. Inconsistency in terminology for painful tendon disorders is a problem at numerous anatomical sites. Historically, the term ‘tendinitis’ was first used to describe tendon pain, thickening and impaired function (online supplementary figure S1). The term ‘tendinosis’ has also been used in a small number of publications, some of which were very influential.2 3 Subsequently, ‘tendinopathy’ emerged as the most common term for persistent tendon pain.4 5 To our knowledge, experts (clinicians and researchers) or patients have never engaged in a formal process to discuss the terminology we use. We believe that health professionals have not yet agreed on the appropriate terminology for painful tendon conditions.Peer reviewedFinal Accepted Versio

Life path analysis: scaling indicates priming effects of social and habitat factors on dispersal distances

1. Movements of many animals along a life-path can be separated into repetitive ones within home ranges and transitions between home ranges. We sought relationships of social and environmental factors with initiation and distance of transition movements in 114 buzzards Buteo buteo that were marked as nestlings with long-life radio tags. 2. Ex-natal dispersal movements of 51 buzzards in autumn were longer than for 30 later in their first year and than 35 extra-natal movements between home ranges after leaving nest areas. In the second and third springs, distances moved from winter focal points by birds that paired were the same or less than for unpaired birds. No post-nuptial movement exceeded 2 km. 3. Initiation of early ex-natal dispersal was enhanced by presence of many sibs, but also by lack of worm-rich loam soils. Distances travelled were greatest for birds from small broods and with relatively little short grass-feeding habitat near the nest. Later movements were generally enhanced by the absence of loam soils and short grassland, especially with abundance of other buzzards and probable poor feeding habitats (heathland, long grass). 4. Buzzards tended to persist in their first autumn where arable land was abundant, but subsequently showed a strong tendency to move from this habitat. 5. Factors that acted most strongly in ½-km buffers round nests, or round subsequent focal points, usually promoted movement compared with factors acting at a larger scale. Strong relationships between movement distances and environmental characteristics in ½-km buffers, especially during early ex-natal dispersal, suggested that buzzards became primed by these factors to travel far. 6. Movements were also farthest for buzzards that had already moved far from their natal nests, perhaps reflecting genetic predisposition, long-term priming or poor habitat beyond the study area

Variabilidade genética e fluxo gênico em populações híbridas e silvestres de pupunha acessada com marcadores RAPD

As populações híbridas de pupunha (Bactris gasipaes Kunth) acumularam variabilidade genética provenientes de raças primitivas ao seu redor, o que deveria aumentar sua variabilidade. Para testar esta hipótese, avaliou-se a variabilidade genética de populações híbridas por meio de marcadores RAPD utilizando 176 plantas mantidas no Banco Ativo de Germoplasma do INPA, Manaus-AM, sendo quatro populações híbridas [Belém (n=26); Manaus (n=38); Iquitos, Peru (n=41); Yurimáguas, Peru (n=41)], duas populações silvestres (B. gasipaes variedade chichagui) tipos 1 (n=21) e 3 (n=7), e duas amostras de espécie afim, B. riparia, e compararam-se os parâmetros genéticos com estudos das raças primitivas. Oito iniciadores RAPD geraram 88 marcadores polimórficos e 11 monomórficos. O teste de replicabilidade apresentou uma similaridade de Dice 0,67, considerado aceitável. A heterozigosidade média das populações híbridas foi 0,34 e o polimorfismo foi 87,9%, maiores que nas silvestres (0,31; 74,7%). O dendrograma das similaridades de Dice não apresentou grupos que representassem claramente as populações híbridas. O fluxo gênico entre Iquitos e Yurimáguas (Nm=12,75) e entre Iquitos e Manaus (Nm=9,47) foi alto, enquanto o fluxo entre Belém e Manaus (Nm=7,72) foi menor que o esperado, possivelmente devido à influência da raça Solimões. O alto valor de heterozigosidade em Manaus (0,31) parece ser resultado da união de duas dispersões após a domesticação: a do oeste amazônico, com Iquitos e Yurimáguas, e a do leste amazônico, com Belém, que se juntam em Manaus. No entanto, essas populações não apresentaram acúmulo de variabilidade genética tão expressiva para diferenciá-las das raças primitivas

Novel colorectal endoscopic in vivo imaging and resection practice: a short practice guide for interventional endoscopists

Colorectal cancer remains a leading cause of cancer death in the UK. With the advent of screening programmes and developing techniques designed to treat and stage colorectal neoplasia, there is increasing pressure on the colonoscopist to keep up to date with the latest practices in this area. This review looks at the basic principles behind endoscopic mucosal resection and forward to the potential endoscopic tools, including high-magnification chromoscopic colonoscopy, high-frequency miniprobe ultrasound and confocal laser scanning endomicroscopic colonoscopy, that may soon become part of routine colorectal cancer management