312 research outputs found

    Clinical research leadership:“A blueprint”

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    Spin and orbital moments of ultra-thin Fe films on various semiconductor surfaces

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    The magnetic moments of ultrathin Fe films on three different III-V semiconductor substrates, namely GaAs, InAs and In0.2Ga0.8As have been measured with X-ray magnetic circular dichroism at room temperature to assess their relative merits as combinations suitable for next-generation spintronic devices. The results revealed rather similar spin moments and orbital moments for the three systems, suggesting the relationship between film and semiconductor lattice parameters to be less critical to magnetic moments than magnetic anisotropy

    Polyunsaturated fatty acids inhibit k<sub>v</sub>1.4 by interacting with positively charged extracellular pore residues

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    Polyunsaturated fatty acids (PUFAs) modulate voltage-gated K(+) channel inactivation by an unknown site and mechanism. The effects of ω-6 and ω-3 PUFAs were investigated on the heterologously expressed K(v)1.4 channel. PUFAs inhibited wild-type K(v)1.4 during repetitive pulsing as a result of slowing of recovery from inactivation. In a mutant K(v)1.4 channel lacking N-type inactivation, PUFAs reversibly enhanced C-type inactivation (K(d), 15–43 μM). C-type inactivation was affected by extracellular H(+) and K(+) as well as PUFAs and there was an interaction among the three: the effect of PUFAs was reversed during acidosis and abolished on raising K(+). Replacement of two positively charged residues in the extracellular pore (H508 and K532) abolished the effects of the PUFAs (and extracellular H(+) and K(+)) on C-type inactivation but had no effect on the lipoelectric modulation of voltage sensor activation, suggesting two separable interaction sites/mechanisms of action of PUFAs. Charge calculations suggest that the acidic head group of the PUFAs raises the pK(a) of H508 and this reduces the K(+) occupancy of the selectivity filter, stabilizing the C-type inactivated state

    Cardiovascular Responses to Orthostasis and Their Association With Falls in Older Adults

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    Background Orthostatic hypotension (OH) refers to a marked decline in blood pressure when upright. OH has a high incidence and prevalence in older adults and represents a potential intrinsic risk factor for falls in these individuals. Previous studies have not included more recent definitions for blood pressure responses to orthostasis, including initial, delayed, and recovery blood pressure responses. Furthermore, there is little research examining the relationships between cerebrovascular functioning and falling risk. Therefore, we aimed to: (i) test the association between different blood pressure responses to orthostatic stress and retrospective falling history and; (ii) test the association between cerebrovascular responses to orthostatic stress and falling history. Methods We tested 59 elderly residents in long term care facilities who underwent a passive seated orthostatic stress test. Beat-to-beat blood pressure and cerebral blood flow velocity (CBFV) responses were assessed throughout testing. Risk factors for falls and falling history were collected from facility records. Cardiovascular responses to orthostasis were compared between retrospective fallers (≥1 fall in the previous year) and non-fallers. Results Retrospective fallers had larger delayed declines in systolic arterial pressure (SAP) compared to non-fallers (p&thinsp; =&thinsp;0.015). Fallers also showed poorer early (2&nbsp;min) and late (15&nbsp;min) recovery of SAP. Fallers had a greater decline in systolic CBFV. Conclusions Older adults with a positive falling history have impaired orthostatic control of blood pressure and CBFV. With better identification and understanding of orthostatic blood pressure impairments earlier intervention and management can be implemented, potentially reducing the associated risk of morbidity and mortality. Future studies should utilize the updated OH definitions using beat-to-beat technology, rather than conventional methods that may offer less accurate detection

    BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice

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    OBJECTIVES: To adapt the supranational European Federation for Periodontology (EFP) S3-Level Clinical Practice Guideline for treatment of periodontitis (stage I-III) to a UK healthcare environment, taking into account the views of a broad range of stakeholders, and patients. SOURCES: This UK version is based on the supranational EFP guideline (Sanz et al., 2020) published in the Journal of Clinical Periodontology. The source guideline was developed using the S3-level methodology, which combined the assessment of formal evidence from 15 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 62 clinical recommendations for the treatment of stage I-III periodontitis, based on a step-wise process mapped to the 2017 classification system. METHODOLOGY: The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for the adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework and following the S3-process, the underlying systematic reviews were updated and a representative guideline group of 75 delegates from 17 stakeholder organisations was assembled into three working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION: Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the dental community in the UK. CLINICAL SIGNIFICANCE: The aim of S3-level guidelines is to combine the evaluation of formal evidence, grading and synthesis with the clinical expertise of a broad range of stakeholders to form clinical recommendations. Herein, the first major international S3-level guideline in dentistry, the EFP guideline, was implemented for direct clinical applicability in the UK healthcare system

    Determination and optimisation of Resonant Acoustic Mixing (RAM) efficiency in Polymer Bonded eXplosive (PBX) processing

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    An investigation into how the efficiency (time and energy required for homogeneity) of Resonant Acoustic Mixing (RAM) can be determined and optimised was undertaken. An idealised Polymer Bonded eXplosive (PBX) simulant based on glass microbeads (28.3 um D50, 62% v/v in binder and plasticiser) was used for mixing. Mixing evolution was monitored using machine output data, whereby the mixer ‘intensity’ (related to power draw) was plotted against time. Experiments were undertaken with three acceleration settings, three mixer units, and three vessel materials of low, medium, and high surface free energy. Different stages of the mixer ‘intensity’ profiles were found to correspond to discrete stages of mixing, as well as further rheological changes due to continued frictional heating, thus viscosity reduction, beyond homogeneity being achieved. Time to mixing completion was found to be repeatable within a standard deviation of +/- 10%, strongly dependent on acceleration setting, and additionally dependent on vessel material, though additional data is required to confirm this. A significant difference in mixing time was observed between different LabRAM units. Partial vacuum application without degassing was beneficial for mixing. Finally, a paradigm linking the ‘movement modes’ of mixing was constructed, based on literature observations and the experimental results

    Social media for physiotherapy clinics: considerations in creating a Facebook page

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    Social media websites play a prominent role in modern society, and the most popular of these websites is Facebook. Increasingly, physiotherapy clinics have begun to utilize Facebook in order to create pages to publicize their services. There are many factors to consider in the planning, implementing, and maintenance of Facebook pages for physiotherapy clinics, including ethical and privacy issues. The primary purpose of creating a page must be clearly defined, with dedicated clinicians given adequate time to manage the page. This technical article discusses these factors and summarizes the experiences at the University of Otago, New Zealand, in creating a Facebook page for the physiotherapy clinic and provides suggestions for physiotherapy clinicians in operating a Facebook page

    Relationships between Orthostatic Hypotension, Frailty, Falling and Mortality in Elderly Care Home Residents

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    Background: Orthostatic hypotension (OH; profound falls in blood pressure when upright) is a common deficit that increases in incidence with age, and may be associated with falling risk. Deficit accumulation results in frailty, regarded as enhanced vulnerability to adverse outcomes. We aimed to evaluate the relationships between OH, frailty, falling and mortality in elderly care home residents. Methods: From the Minimum Data Set (MDS) document, a frailty index (FI-MDS) was generated from a list of 58 deficits, ranging from 0 (no deficits) to 1.0 (58 deficits). OH was evaluated from beat-to-beat blood pressure and heart rate (finger plethysmography) collected during a 15-min supine-seated orthostatic stress test. Retrospective and prospective falling rates (falls/year) were extracted from facility falls incident reports. All-cause 3-year mortality was determined. Data are reported as mean ± standard error. Results: Data were obtained from 116 older adults (aged 84.2 ± 0.9 years; 44% males) living in two long term care facilities. The mean FI-MDS was 0.36 ± 0.01; FI-MDS was correlated with age (r = 0.277; p = 0.003). Those who were frail (FI ≥ 0.27) had larger Initial (− 17.8 ± 4.2 vs − 6.1 ± 3.3 mmHg, p = 0.03) and Consensus (− 22.7 ± 4.3 vs − 11.5 ± 3. 3 mmHg, p = 0.04) orthostatic reductions in systolic arterial pressure. Frail individuals had higher prospective and retrospective falling rates and higher 3-year mortality. Receiver operating characteristic curves evaluated the ability of FI-MDS alone to predict prospective falls (sensitivity 72%, specificity 36%), Consensus OH (sensitivity 68%, specificity 60%) and 3-year mortality (sensitivity 77%, specificity 49%). Kaplan Meier survival analyses showed significantly higher 3-year mortality in those who were frail compared to the non-frail (p = 0.005). Conclusions: Frailty can be captured using a frailty index based on MDS data in elderly individuals living in long term care, and is related to susceptibility to orthostatic hypotension, falling risk and 3-year mortality. Use of the MDS to generate a frailty index may represent a simple and convenient risk assessment tool for older adults living in long term care. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this ris
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