The Implications of living with Heart Failure; the impact on everyday life, family support, co-morbidities and access to healthcare: A secondary qualitative analysis

Background: The aim of this study was to use secondary analysis to interrogate a qualitative data set to explore the experiences of patients living with heart failure. Methods: The data-set comprised interviews with 11 patients who had participated in an ethnographic study of heart failure focusing on unplanned hospital admissions. Following an initial review of the literature, a framework was developed with which to interrogate the data-set. This was modified in light of analysis of the first two interviews, to focus on the rich data around patients’ perceptions of living with heart failure, managing co-morbidities, accessing healthcare and the role of their family and friends, during their illness journey. Results: Respondents described how the symptoms of heart failure impacted on their daily lives and how disruption of routine activity due to their symptoms caused them to seek medical care. Respondents disclosed the difficulties of living with other illnesses, in addition to their heart failure, particularly managing multiple and complex medication regimes and negotiating multiple appointments; all expressed a desire to return to their pre-morbid, more independent lives. Many respondents described uncertainty around diagnosis and delays in communication from their healthcare providers. The importance of family support was emphasised, but respondents worried about burdening relatives with their illness. Conclusion: Living with heart failure causes disruption to the lives of sufferers. Facilitation of access to healthcare, through good communication between services and having a strong support network of both family and clinicians can reduce the impact of heart failure on the lives of the patient and those around them

Self-generated magnetic flux in YBa2_2Cu3_3O7−x_{7-x} grain boundaries

Grain boundaries in YBa$_2$Cu$_3$O$_{7-x}$ superconducting films are considered as Josephson junctions with a critical current density $j_c(x)$ alternating along the junction. A self-generated magnetic flux is treated both analytically and numerically for an almost periodic distribution of $j_c(x)$. We obtained a magnetic flux-pattern similar to the one which was recently observed experimentally.Comment: 7 pages, 3 figure

Partial wave analysiss of pbar-p -> piminus-piplus, pizero-pizero, eta-eta and eta-etaprime

A partial wave analysis is presented of Crystal Barrel data on pbar-p -> pizero-pizero, eta-eta and eta-etaprime from 600 to 1940 MeV/c, combined with earlier data on d\sigma /d\Omega and P for pbar-p->piminus-piplus. The following s-channel I=0 resonances are identified: (i) J^{PC} = 5^{--} with mass and width (M,\Gamma) at (2295+-30,235^{+65}_{-40}) MeV, (ii) J^{PC} = 4^{++} at (2020+-12, 170+-15) MeV and (2300+-25, 270+-50) MeV, (iii) 3D3 JPC = 3^{--} at (1960+-15, 150+-25) MeV and (2210+-4$, 360+-55) MeV, and a 3G3 state at (2300 ^{+50}_{-80}, 340+-150) MeV, (iv) JPC = 2^{++} at (1910+-30, 260+-40) MeV, (2020+-30, 275+-35) MeV, (2230+-30, 245+-45) MeV, and (2300+-35, 290+-50) MeV, (v) JPC = 1^{--} at (2005+-40, 275+-75) MeV, and (2165+-40, 160 ^{+140}_{-70}) MeV, and (vi) JPC = 0^{++} at (2005+-30, 305+-50) MeV, (2105+-15, 200+-25) MeV, and (2320+-30, 175+-45) MeV. In addition, there is a less well defined 6^{++} resonance at 2485+-40 MeV, with Gamma = 410+-90 MeV. For every JP, almost all these resonances lie on well defined linear trajectories of mass squared v. excitation number. The slope is 1.10+-0.03 Gev^2 per excitation. The f_0(2105) has strong coupling to eta-\eta, but much weaker coupling to pizero-pizero. Its flavour mixing angle between q-qbar and s-sbar is (59-71.6)deg, i.e. dominant decays to s-sbar. Such decays and its strong production in pbar-p interactions strongly suggest exotic character.Comment: Makes available the combined fit to Crystal Barrel data on pbar-p -> 2-body final states. 29 pages, 11 figures. Typo corrected in version

Non-pharmacological interventions for the management of perinatal anxiety in primary care: a meta-review of systematic reviews

Background Perinatal anxiety (PNA), anxiety that occurs during pregnancy and/or up to 12 months postpartum, is estimated to affect up to 21% of women, and may impact negatively on mothers, children, and their families. The National Institute for Health and Care Excellence (NICE) has called for further research around non-pharmacological interventions in primary care for PNA. Aim To summarise the available international evidence on non-pharmacological interventions for women with PNA in a primary care population. Design & setting A meta-review of systematic reviews (SRs) with narrative synthesis was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Method Systematic literature searches were conducted in 11 health-related databases up to June 2022. Titles, abstracts, and full-text articles were dual-screened against pre-defined eligibility criteria. A variety of study designs were included. Data were extracted about study participants, intervention design, and context. Quality appraisal was performed using the AMSTAR 2 tool (A MeaSurement Tool to Assess systematic Reviews). A patient and public involvement group informed and contributed towards this meta-review. Results Twenty-four SRs were included in the meta-review. Interventions were grouped into the following six categories for analysis purposes: psychological therapies; mind–body activities; emotional support from healthcare professionals (HCPs); peer support; educational activities; and alternative or complementary therapies. Conclusion In addition to pharmacological and psychological therapies, this meta-review has demonstrated that there are many more options available for women to choose from that might be effective to manage their PNA. Evidence gaps are present in several intervention categories. Primary care clinicians and commissioners should endeavour to provide patients with a choice of these management options, promoting individual choice and patient-centred care

The experiences and needs of supporting individuals of young people who self-harm: A systematic review and thematic synthesis

Self-harm in young people is a serious international health concern that impacts on those providing informal support: the supporting individuals of young people. We aimed to highlight the experiences, views, and needs of these supporting individuals of young people. We conducted a systematic review and thematic synthesis: PROSPERO CRD42020168527. MEDLINE, PsycINFO, EMBASE, AMED, CINAHL, ASSIA, and Web of Science were searched from inception to 6 May 2020 with citation tracking of eligible studies done on 1 Oct 2021. Primary outcomes were experiences, perspectives, and needs of parents, carers, or other family members of young people aged 12-25. Searches found 6167 citations, of which 22 papers were included in synthesis. Supporting individuals seek an explanation for and were personally affected by self-harm in young people. It is important that these individuals are themselves supported, especially as they negotiate new identities when handling self-harm in young people, as they attempt to offer support. The GRADE-CERQual confidence in findings is moderate. Recommendations informed by the synthesis findings are made for the future development of interventions. Clinicians and health service providers who manage self-harm in young people should incorporate these identified unmet needs of supporting individuals in a holistic approach to self-harm care. Future research must co-produce and evaluate interventions for supporting individuals

Working conditions, psychological distress and suicidal ideation: cross-sectional survey study of UK junior doctors

Background Evidence attests a link between junior doctors’ working conditions and psychological distress. Despite increasing concerns around suicidality among junior doctors, little is known about its relationship to their working conditions. Aims To (a) establish the prevalence of suicidal ideation among junior doctors in the National Health Service; (b) examine the relationships between perceived working conditions and suicidal ideation; and (c) explore whether psychological distress (e.g. symptoms of depression and anxiety) mediates these relationships. Method Junior doctors were recruited between March 2020 and January 2021, for a cross-sectional online survey. We used the Health and Safety Executive's Management Standards Tool; Depression, Anxiety and Stress Scale 21; and Paykel Suicidality Scale to assess working conditions, psychological distress and suicidality, respectively. Results Of the 424 participants, 50.2% reported suicidal ideation, including 6.1% who had made an attempt on their own life. Participants who identified as LGBTQ+ (odds ratio 2.18, 95% CI 1.15–4.12) or reported depression symptoms (odds ratio 1.10, 95% CI 1.07–1.14) were more likely to report suicidal ideation. No direct relationships were reported between working conditions (i.e. control, support, role clarity, strained relationships, demand and change) and suicidal ideation. However, depression symptoms mediated all six relationships. Conclusions This sample of junior doctors reported alarming levels of suicidal ideation. There may be an indirect relationship between working conditions and suicidal ideation via depressive symptoms. Clearer research exploring the experience of suicidality in junior doctors is needed, including those who identify as LGBTQ+. Systematic interventions addressing working environment are needed to support junior doctors’ mental health

Effective Lagrangian Approach to the Theory of Eta Photoproduction in the N∗(1535)N^{*}(1535) Region

We investigate eta photoproduction in the $N^{*}(1535)$ resonance region within the effective Lagrangian approach (ELA), wherein leading contributions to the amplitude at the tree level are taken into account. These include the nucleon Born terms and the leading $t$-channel vector meson exchanges as the non-resonant pieces. In addition, we consider five resonance contributions in the $s$- and $u$- channel; besides the dominant $N^{*}(1535)$, these are: $N^{*}(1440),N^{*}(1520),N^{*}(1650)$ and $N^{*}(1710)$. The amplitudes for the $\pi^\circ$ and the $\eta$ photoproduction near threshold have significant differences, even as they share common contributions, such as those of the nucleon Born terms. Among these differences, the contribution to the $\eta$ photoproduction of the $s$-channel excitation of the $N^{*}(1535)$ is the most significant. We find the off-shell properties of the spin-3/2 resonances to be important in determining the background contributions. Fitting our effective amplitude to the available data base allows us to extract the quantity $\sqrt{\chi \Gamma_\eta} A_{1/2}/\Gamma_T$, characteristic of the photoexcitation of the $N^{*}(1535)$ resonance and its decay into the $\eta$-nucleon channel, of interest to precise tests of hadron models. At the photon point, we determine it to be $(2.2\pm 0.2)\times 10^{-1} GeV^{-1}$ from the old data base, and $(2.2\pm 0.1) \times 10^{-1} GeV^{-1}$ from a combination of old data base and new Bates data. We obtain the helicity amplitude for $N^{*}(1535)\rightarrow \gamma p$ to be $A_{1/2}=(97\pm 7)\times 10^{-3} GeV^{-1/2}$ from the old data base, and $A_{1/2}=(97\pm 6)\times 10^{-3} GeV^{-1/2}$ from the combination of the old data base and new Bates data, compared with the results of the analysis of pion photoproduction yielding $74\pm 11$, in the same units.Comment: 43 pages, RevTeX, 9 figures available upon request, to appear in Phys. Rev.

Development of the oral resistome during the first decade of life

Published online: 09 March 2023Antibiotic overuse has promoted the spread of antimicrobial resistance (AMR) with significant health and economic consequences. Genome sequencing reveals the widespread presence of antimicrobial resistance genes (ARGs) in diverse microbial environments. Hence, surveillance of resistance reservoirs, like the rarely explored oral microbiome, is necessary to combat AMR. Here, we characterise the development of the paediatric oral resistome and investigate its role in dental caries in 221 twin children (124 females and 97 males) sampled at three time points over the first decade of life. From 530 oral metagenomes, we identify 309 ARGs, which significantly cluster by age, with host genetic effects detected from infancy onwards. Our results suggest potential mobilisation of ARGs increases with age as the AMR associated mobile genetic element, Tn916 transposase was co-located with more species and ARGs in older children. We find a depletion of ARGs and species in dental caries compared to health. This trend reverses in restored teeth. Here we show the paediatric oral resistome is an inherent and dynamic component of the oral microbiome, with a potential role in transmission of AMR and dysbiosis.Smitha Sukumar, FangWang, Carra A. Simpson, Cali E. Willet, Tracy Chew, Toby E. Hughes, Michelle R. Bockmann, Rosemarie Sadsad, F. ElizabethMartin, Henry W. Lydecker, Gina V. Browne, KylieM. Davis, Minh Bui, ElenaMartinez, Christina J. Adle

Markers of dementia-related health in primary care electronic health records

Objectives: Identifying routinely recorded markers of poor health in patients with dementia may help treatment decisions and evaluation of earlier outcomes in research. Our objective was to determine whether a set of credible markers of dementia-related health could be identified from primary care electronic health records (EHR). Methods: The study consisted of (i) rapid review of potential measures of dementia-related health used in EHR studies; (ii) consensus exercise to assess feasibility of identifying these markers in UK primary care EHR; (iii) development of UK EHR code lists for markers; (iv) analysis of a regional primary care EHR database to determine further potential markers; (v) consensus exercise to finalise markers and pool into higher domains; (vi) determination of 12-month prevalence of domains in EHR of 2328 patients with dementia compared to matched patients without dementia. Results: Sixty-three markers were identified and mapped to 13 domains: Care; Home Pressures; Severe Neuropsychiatric; Neuropsychiatric; Cognitive Function; Daily Functioning; Safety; Comorbidity; Symptoms; Diet/Nutrition; Imaging; Increased Multimorbidity; Change in Dementia Drug. Comorbidity was the most prevalent recorded domain in dementia (69%). Home Pressures were the least prevalent domain (1%). Ten domains had a statistically significant higher prevalence in dementia patients, one (Comorbidity) was higher in non-dementia patients, and two (Home Pressures, Diet/Nutrition) showed no association with dementia. Conclusions: EHR captures important markers of dementia-related health. Further research should assess if they indicate dementia progression. These markers could provide the basis for identifying individuals at risk of faster progression and outcome measures for use in research