Patient experience and satisfaction with symptomatic Faecal Immunochemical Testing: An explanatory sequential mixed-methods evaluation

Background: Recent evidence suggests that faecal immunochemical testing (FIT) can rule out colorectal cancer in symptomatic adults. To date, there is little research exploring experiences of FIT for this population. Aim: To explore patient experience and satisfaction with FIT in an ‘early adopter’ site in England. Design: We used an explanatory sequential mixed-methods approach combining mailed quantitative surveys with semi-structured telephone interviews. Methods: Multivariate logistic regression was used to analyse quantitative data. Thematic analysis was used to assess qualitative transcripts. Results: The survey had 260 respondents and found satisfaction with FIT was high (88.7%). Compared with test satisfaction, the proportion of respondents satisfied with GP consultation, and how they received their results, was lower (74.4% and 76.2%, respectively). Multivariate analysis showed increased area-level deprivation and not receiving an explanation of the purpose of the test were associated with lower satisfaction with GP consultation (both P-values<0.05), while increased area-level deprivation and not receiving results from the GP were associated with lower satisfaction with receiving results (both P-values<0.05). Interviews with respondents (n=20) helped explain the quantitative results. They revealed that “not knowing the purpose of the test” caused “anxiety” and “confusion”, which led to dissatisfaction. “Not receiving results from GP” was considered “unacceptable”, as this left patients with a “niggling doubt” and lack of diagnosis, or assurance that they did not have cancer. Conclusion: Patient satisfaction with symptomatic FIT is high. Efforts to improve satisfaction should focus on ensuring patients understand the purpose of the test and always receive their test results

New insights on single-stranded versus double-stranded DNA library preparation for ancient DNA

An innovative single-stranded DNA (ssDNA) library preparation method has sparked great interest among ancient DNA (aDNA) researchers, especially after reports of endogenous DNA content increases &gt;20-fold in some samples. To investigate the behavior of this method, we generated ssDNA and conventional double-stranded DNA (dsDNA) libraries from 23 ancient and historic plant and animal specimens. We found ssDNA library preparation substantially increased endogenous content when dsDNA libraries contained &lt;3% endogenous DNA, but this enrichment is less pronounced when dsDNA preparations successfully recover short endogenous DNA fragments (mean size &lt; 70 bp). Our findings can help researchers determine when to utilize the time- and resource-intensive ssDNA library preparation method. </jats:p

Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation:a systematic review, meta-analysis, and narrative synthesis

BACKGROUND: Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce involuntary hospitalisation. We did a systematic review, meta-analysis, and narrative synthesis to investigate risk factors at the patient, service, and area level associated with involuntary psychiatric hospitalisation of adults. METHODS: We searched MEDLINE, PsycINFO, Embase, and the Cochrane Controlled Clinical Register of Trials from Jan 1, 1983, to Aug 14, 2019, for studies comparing the characteristics of voluntary and involuntary psychiatric inpatients, and studies investigating the characteristics of involuntarily hospitalised individuals in general population samples. We synthesised results using random effects meta-analysis and narrative synthesis. Our review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered on PROSPERO, CRD42018095103. FINDINGS: 77 studies were included from 22 countries. Involuntary rather than voluntary hospitalisation was associated with male gender (odds ratio 1·23, 95% CI 1·14-1·32; p<0·0001), single marital status (1·47, 1·18-1·83; p<0·0001), unemployment (1·43, 1·07-1·90; p=0·020), receiving welfare benefits (1·71, 1·28-2·27; p<0·0001), being diagnosed with a psychotic disorder (2·18, 1·95-2·44; p<0·0001) or bipolar disorder (1·48, 1·24-1·76; p<0·0001), and previous involuntary hospitalisation (2·17, 1·62-2·91; p<0·0001). Using narrative synthesis, we found associations between involuntary psychiatric hospitalisation and perceived risk to others, positive symptoms of psychosis, reduced insight into illness, reduced adherence to treatment before hospitalisation, and police involvement in admission. On a population level, some evidence was noted of a positive dose-response relation between area deprivation and involuntary hospitalisation. INTERPRETATION: Previous involuntary hospitalisation and diagnosis of a psychotic disorder were factors associated with the greatest risk of involuntary psychiatric hospitalisation. People with these risk factors represent an important target group for preventive interventions, such as crisis planning. Economic deprivation on an individual level and at the population level was associated with increased risk for involuntary hospitalisation. Mechanisms underpinning the risk factors could not be identified using the available evidence. Further research is therefore needed with an integrative approach, which examines clinical, social, and structural factors, alongside qualitative research into clinical decision-making processes and patients' experiences of the detention process. FUNDING: Commissioned by the Department of Health and funded by the National Institute of Health Research (NIHR) via the NIHR Mental Health Policy Research Unit

Why, what, and how? case study on law, risk, and decision making as necessary themes in built environment teaching

The paper considers (and defends) the necessity of including legal studies as a core part of built environment undergraduate and postgraduate curricula. The writer reflects upon his own experience as a lawyer working alongside and advising built environment professionals in complex land remediation and site safety management situations in the United Kingdom and explains how themes of liability, risk, and decision making can be integrated into a practical simulation in order to underpin more traditional lecture-based law teaching. Through reflection upon the writer's experiments with simulation-based teaching, the paper suggests some innovations that may better orientate law teaching to engage these themes and, thereby, enhance the relevance of law studies to the future needs of built environment professionals in practice.</p

Measuring hope amongst Tanzanian women who participate in microfinance: An evaluation of the Snyder hope scale.

Measuring hope reliably and accurately remains an important research objective, not least in less prosperous settings where 'holding on to hope' may be critically important in the struggle against adverse life conditions. The State Hope Scale was designed for use in the US. Despite reported application in diverse cultures and using translations the scale has not been extensively validated outside US populations. This study contributes to a larger project exploring the measurement of hope and provides a critique of Snyder's scale as used in a Tanzanian female population of 1021 urban microfinance participants. We evaluate the scale's validity through assessment of the empirical distribution of scores, item response profiles, internal consistency and discriminatory ability. Participants mostly scored very high and many reached very near the maximum attainable score. Hardly any endorsed the negative half of the response scale. Several problems are discussed including poor discrimination and strong evidence of acquiescence response bias. We also found little association of the scale scores with hypothesised correlates of hope. Future improvements on the measurement of hope are recommended, especially in studies outside the narrow Western context in which the scale was devised

An algebraic/numerical formalism for one-loop multi-leg amplitudes

We present a formalism for the calculation of multi-particle one-loop amplitudes, valid for an arbitrary number N of external legs, and for massive as well as massless particles. A new method for the tensor reduction is suggested which naturally isolates infrared divergences by construction. We prove that for N>4, higher dimensional integrals can be avoided. We derive many useful relations which allow for algebraic simplifications of one-loop amplitudes. We introduce a form factor representation of tensor integrals which contains no inverse Gram determinants by choosing a convenient set of basis integrals. For the evaluation of these basis integrals we propose two methods: An evaluation based on the analytical representation, which is fast and accurate away from exceptional kinematical configurations, and a robust numerical one, based on multi-dimensional contour deformation. The formalism can be implemented straightforwardly into a computer program to calculate next-to-leading order corrections to multi-particle processes in a largely automated way.Comment: 71 pages, 7 figures, formulas for rank 6 pentagons added in Appendix

Toxic Exposure of Songbirds to Lead in the Southeast Missouri Lead Mining District

Mining and smelting in the Southeast Missouri Lead Mining District has caused widespread contamination of soils with lead (Pb) and other metals. Soils from three study sites sampled in the district contained from approximately 1,000–3,200 mg Pb/kg. Analyses of earthworms [33–4,600 mg Pb/kg dry weight (dw)] collected in the district showed likely high Pb exposure of songbirds preying on soil organisms. Mean tissue Pb concentrations in songbirds collected from the contaminated sites were greater (p \u3c 0.05) than those in songbirds from reference sites by factors of 8 in blood, 13 in liver, and 23 in kidney. Ranges of Pb concentrations in livers (mg Pb/kg dw) were as follows: northern cardinal (Cardinalis cardinalis) = 0.11–3.0 (reference) and 1.3–30 (contaminated) and American robin (Turdus migratorius) = 0.43–8.5 (reference) and 7.6–72 (contaminated). Of 34 adult and juvenile songbirds collected from contaminated sites, 11 (32 %) had hepatic Pb concentrations that were consistent with adverse physiological effects, 3 (9 %) with systemic toxic effects, and 4 (12 %) with life-threatening toxic effects. Acid-fast renal intranuclear inclusion bodies, which are indicative of Pb poisoning, were detected in kidneys of two robins that had the greatest renal Pb concentrations (952 and 1,030 mg/kg dw). Mean activity of the enzyme delta-aminolevulinic acid dehydratase (ALAD) in red blood cells, a well-established bioindicator of Pb poisoning in birds, was decreased by 58–82 % in songbirds from the mining sites. We conclude that habitats within the mining district with soil Pb concentrations of C1,000 mg Pb/kg are contaminated to the extent that they are exposing ground-feeding songbirds to toxic concentrations of Pb

Toxic Exposure of Songbirds to Lead in the Southeast Missouri Lead Mining District

Mining and smelting in the Southeast Missouri Lead Mining District has caused widespread contamination of soils with lead (Pb) and other metals. Soils from three study sites sampled in the district contained from approximately 1,000–3,200 mg Pb/kg. Analyses of earthworms [33–4,600 mg Pb/kg dry weight (dw)] collected in the district showed likely high Pb exposure of songbirds preying on soil organisms. Mean tissue Pb concentrations in songbirds collected from the contaminated sites were greater (p \u3c 0.05) than those in songbirds from reference sites by factors of 8 in blood, 13 in liver, and 23 in kidney. Ranges of Pb concentrations in livers (mg Pb/kg dw) were as follows: northern cardinal (Cardinalis cardinalis) = 0.11–3.0 (reference) and 1.3–30 (contaminated) and American robin (Turdus migratorius) = 0.43–8.5 (reference) and 7.6–72 (contaminated). Of 34 adult and juvenile songbirds collected from contaminated sites, 11 (32 %) had hepatic Pb concentrations that were consistent with adverse physiological effects, 3 (9 %) with systemic toxic effects, and 4 (12 %) with life-threatening toxic effects. Acid-fast renal intranuclear inclusion bodies, which are indicative of Pb poisoning, were detected in kidneys of two robins that had the greatest renal Pb concentrations (952 and 1,030 mg/kg dw). Mean activity of the enzyme delta-aminolevulinic acid dehydratase (ALAD) in red blood cells, a well-established bioindicator of Pb poisoning in birds, was decreased by 58–82 % in songbirds from the mining sites. We conclude that habitats within the mining district with soil Pb concentrations of C1,000 mg Pb/kg are contaminated to the extent that they are exposing ground-feeding songbirds to toxic concentrations of Pb

Effect of metoprolol on myocardial function and energetics in patients with nonischemic dilated cardiomyopathy: A randomized, double-blind, placebo-controlled study

AbstractObjectives. This study examined the of metoprolol on left ventricular performance, efficiency, neurohormonal activation and myocardial respiratory quotient in patients with dilated cardiomyopathy.Background.The mechanism by which beta-adrenergie blockade improves ejection fraction in patients with dilated cardiomyopathy remains an enigma. Thus, we undertook an extensive hemodynamic evaluation of this mechanism. In addition, because animal models have shown that catecholamine exposure may increase relative fatty acid utilization, we hypothesized that antagonism of sympathetic stimulation may result in increased carbohydrate utilization.Methods. This was a randomized, double-blind, prospective trial in which 24 men with nonischemic dilated cardiomyopathy underwent cardiac catheterization before and after 3 months of therapy with metoprolol (n = 15) or placebo (n = 9) in addition to standard therapy. Pressure-volume relations were examined using a micromanometer catheter and digital ventriculography.Results. At baseline, the placebo-treated patients had somewhat more advanced left ventricular dysfunction. Ejection fraction and left ventricular performance improved only in the metoprolol-treated patients. Stroke and minute work increased without an increase in myocardial oxgen consumption, suggesting increased myocardial efficiency. Further increases in ejection fraction were seen between 3 and 6 months in the metoprolol group. The placebo group had a significant increase in ejection fraction only after crossover to metoprolol. A significant relation the change in coronary sinus norepinephrine and myocardial respiratory quotient was seen, suggesting a possible effect of adrenergic deactivation on substrate utilization.Conclusions. These data demonstrate that in patients with cardiomyopthy, metoprolol treatment improves myocardial performance and energetics, and favorably alters substrate utilization. Beta-adrenergic blocking agents, such as metoprolol, are hemodynamically and energetically beneficial in the treatment of myocardial failure