Collaborative working within UK NHS secondary care and across sectors for COPD and the impact of peer review : qualitative findings from the UK National COPD Resources and Outcomes Project

Introduction: We investigated the effects on collaborative work within the UK National Health Service (NHS) of an intervention for service quality improvement: informal, structured, reciprocated, multidisciplinary peer review with feedback and action plans. The setting was care for chronic obstructive pulmonary disease (COPD). Theory and methods: We analysed semi-structured interviews with 43 hospital respiratory consultants, nurses and general managers at 24 intervention and 11 control sites, as part of a UK randomised controlled study, the National COPD Resources and Outcomes Project (NCROP), using Scott’s conceptual framework for action (inter-organisational, intra-organisational, inter-professional and inter-individual). Three areas of care targeted by NCROP involved collaboration across primary and secondary care. Results: Hospital respiratory department collaborations with commissioners and hospital managers varied. Analysis suggested that this is related to team responses to barriers. Clinicians in unsuccessful collaborations told ‘atrocity stories’ of organisational, structural and professional barriers to service improvement. The others removed barriers by working with government and commissioner agendas to ensure continued involvement in patients’ care. Multidisciplinary peer review facilitated collaboration between participants, enabling them to meet, reconcile differences and exchange ideas across boundaries. Conclusions: The data come from the first randomised controlled trial of organisational peer review, adding to research into UK health service collaborative work, which has had a more restricted focus on inter-professional relations. NCROP peer review may only modestly improve collaboration but these data suggest it might be more effective than top-down exhortations to change when collaboration both across and within organisations is required

The potential role of creatine in vascular health

Creatine is an organic compound, consumed exogenously in the diet and synthesized endogenously via an intricate inter-organ process. Functioning in conjunction with creatine kinase, creatine has long been known for its pivotal role in cellular energy provision and energy shuttling. In addition to the abundance of evidence supporting the ergogenic benefits of creatine supplementation, recent evidence suggests a far broader application for creatine within various myopathies, neurodegenerative diseases, and other pathologies. Furthermore, creatine has been found to exhibit non-energy related properties, contributing as a possible direct and in-direct antioxidant and eliciting anti-inflammatory effects. In spite of the new clinical success of supplemental creatine, there is little scientific insight into the potential effects of creatine on cardiovascular disease (CVD), the leading cause of mortality. Taking into consideration the non-energy related actions of creatine, highlighted in this review, it can be speculated that creatine supplementation may serve as an adjuvant therapy for the management of vascular health in at-risk populations. This review, therefore, not only aims to summarize the current literature surrounding creatine and vascular health, but to also shed light onto the potential mechanisms in which creatine may be able to serve as a beneficial supplement capable of imparting vascular-protective properties and promoting vascular health

Bayesian analysis of polarization measurements

A detailed and formal account of polarization measurements using Bayesian analysis is given based on the assumption of gaussian error for the Stokes parameters. This analysis is crucial for the measurement of the polarization degree and angle at very low (and very high) signal-to-noise. The treatment serves as a framework for customized analysis of data based on a particular prior suited to the experiment.Comment: 15 page

Flight test of the X-29A at high angle of attack: Flight dynamics and controls

The NASA Dryden Flight Research Center has flight tested two X-29A aircraft at low and high angles of attack. The high-angle-of-attack tests evaluate the feasibility of integrated X-29A technologies. More specific objectives focus on evaluating the high-angle-of-attack flying qualities, defining multiaxis controllability limits, and determining the maximum pitch-pointing capability. A pilot-selectable gain system allows examination of tradeoffs in airplane stability and maneuverability. Basic fighter maneuvers provide qualitative evaluation. Bank angle captures permit qualitative data analysis. This paper discusses the design goals and approach for high-angle-of-attack control laws and provides results from the envelope expansion and handling qualities testing at intermediate angles of attack. Comparisons of the flight test results to the predictions are made where appropriate. The pitch rate command structure of the longitudinal control system is shown to be a valid design for high-angle-of-attack control laws. Flight test results show that wing rock amplitude was overpredicted and aileron and rudder effectiveness were underpredicted. Flight tests show the X-29A airplane to be a good aircraft up to 40 deg angle of attack

Synthesis of satellite (MODIS), aircraft (ICARTT), and surface (IMPROVE, EPA-AQS, AERONET) aerosol observations over eastern North America to improve MODIS aerosol retrievals and constrain surface aerosol concentrations and sources

We use an ensemble of satellite (MODIS), aircraft, and ground-based aerosol observations during the ICARTT field campaign over eastern North America in summer 2004 to (1) examine the consistency between different aerosol measurements, (2) evaluate a new retrieval of aerosol optical depths (AODs) and inferred surface aerosol concentrations (PM2.5) from the MODIS satellite instrument, and (3) apply this collective information to improve our understanding of aerosol sources. The GEOS-Chem global chemical transport model (CTM) provides a transfer platform between the different data sets, allowing us to evaluate the consistency between different aerosol parameters observed at different times and locations. We use an improved MODIS AOD retrieval based on locally derived visible surface reflectances and aerosol properties calculated from GEOS-Chem. Use of GEOS-Chem aerosol optical properties in the MODIS retrieval not only results in an improved AOD product but also allows quantitative evaluation of model aerosol mass from the comparison of simulated and observed AODs. The aircraft measurements show narrower aerosol size distributions than those usually assumed in models, and this has important implications for AOD retrievals. Our MODIS AOD retrieval compares well to the ground-based AERONET data (R = 0.84, slope = 1.02), significantly improving on the MODIS c005 operational product. Inference of surface PM2.5 from our MODIS AOD retrieval shows good correlation to the EPA-AQS data (R = 0.78) but a high regression slope (slope = 1.48). The high slope is seen in all AOD-inferred PM2.5 concentrations (AERONET: slope = 2.04; MODIS c005: slope = 1.51) and could reflect a clear-sky bias in the AOD observations. The ensemble of MODIS, aircraft, and surface data are consistent in pointing to a model overestimate of sulfate in the mid-Atlantic and an underestimate of organic and dust aerosol in the southeastern United States. The sulfate overestimate could reflect an excessive contribution from aqueous-phase production in clouds, while the organic carbon underestimate could possibly be resolved by a new secondary pathway involving dicarbonyls

Evidence for Quantized Displacement in Macroscopic Nanomechanical Oscillators

We report the observation of discrete displacement of nanomechanical oscillators with gigahertz-range resonance frequencies at millikelvin temperatures. The oscillators are nanomachined single-crystal structures of silicon, designed to provide two distinct sets of coupled elements with very low and very high frequencies. With this novel design, femtometer-level displacement of the frequency-determining element is amplified into collective motion of the entire micron-sized structure. The observed discrete response possibly results from energy quantization at the onset of the quantum regime in these macroscopic nanomechanical oscillators.Comment: 4 pages, two-column format. Related papers available at http://nano.bu.edu

The role of iron uptake in pathogenicity and symbiosis in Photorhabdus luminescens TT01

<p>Abstract</p> <p>Background</p> <p><it>Photorhabdus </it>are Gram negative bacteria that are pathogenic to insect larvae whilst also having a mutualistic interaction with nematodes from the family <it>Heterorhabditis</it>. Iron is an essential nutrient and bacteria have different mechanisms for obtaining both the ferrous (Fe²⁺) and ferric (Fe³⁺) forms of this metal from their environments. In this study we were interested in analyzing the role of Fe³⁺and Fe²⁺iron uptake systems in the ability of <it>Photorhabdus </it>to interact with its invertebrate hosts.</p> <p>Results</p> <p>We constructed targeted deletion mutants of <it>exbD</it>, <it>feoABC </it>and <it>yfeABCD </it>in <it>P. luminescens </it>TT01. The <it>exbD </it>mutant was predicted to be crippled in its ability to obtain Fe³⁺and we show that this mutant does not grow well in iron-limited media. We also show that this mutant was avirulent to the insect but was unaffected in its symbiotic interaction with <it>Heterorhabditis</it>. Furthermore we show that a mutation in <it>feoABC </it>(encoding a predicted Fe²⁺permease) was unaffected in both virulence and symbiosis whilst the divalent cation transporter encoded by <it>yfeABCD </it>is required for virulence in the Tobacco Hornworm, <it>Manduca sexta </it>(Lepidoptera) but not in the Greater Wax Moth, <it>Galleria mellonella </it>(Lepidoptera). Moreover the Yfe transporter also appears to have a role during colonization of the IJ stage of the nematode.</p> <p>Conclusion</p> <p>In this study we show that iron uptake (via the TonB complex and the Yfe transporter) is important for the virulence of <it>P. luminescens </it>to insect larvae. Moreover this study also reveals that the Yfe transporter appears to be involved in Mn²⁺-uptake during growth in the gut lumen of the IJ nematode. Therefore, the Yfe transporter in <it>P. luminescens </it>TT01 is important during colonization of both the insect and nematode and, moreover, the metal ion transported by this pathway is host-dependent.</p

Exploring the biochemistry at the extracellular redox frontier of bacterial mineral Fe(III) respiration

Many species of the bacterial Shewanella genus are notable for their ability to respire in anoxic environments utilizing insoluble minerals of Fe(III) and Mn(IV) as extracellular electron acceptors. In Shewanella oneidensis, the process is dependent on the decahaem electron-transport proteins that lie at the extracellular face of the outer membrane where they can contact the insoluble mineral substrates. These extracellular proteins are charged with electrons provided by an inter-membrane electron-transfer pathway that links the extracellular face of the outer membrane with the inner cytoplasmic membrane and thereby intracellular electron sources. In the present paper, we consider the common structural features of two of these outer-membrane decahaem cytochromes, MtrC and MtrF, and bring this together with biochemical, spectroscopic and voltammetric data to identify common and distinct properties of these prototypical members of different clades of the outer-membrane decahaem cytochrome superfamily

Cigarette smoking and risk of severe infectious respiratory diseases in UK adults: 12-year follow-up of UK biobank

Background: The relevance of tobacco smoking for infectious respiratory diseases (IRD) is uncertain. We investigated the associations of cigarette smoking with severe IRD resulting in hospitalization or death in UK adults. Methods: We conducted a prospective study of cigarette smoking and risk of severe IRD in UK Biobank. The outcomes included pneumonia, other acute lower respiratory tract infections (OA-LRTI) and influenza. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) of severe IRD associated with smoking habits after adjusting for confounding factors. Results: Among 341 352 participants with no prior history of major chronic diseases, there were 12 384 incident cases with pneumonia, 7054 with OA-LRTI and 795 with influenza during a 12-year follow-up. Compared with non-smokers, current smoking was associated with ⁓2-fold higher rates of severe IRD (HR 2.40 [2.27–2.53] for pneumonia, 1.99 [1.84–2.14] for OA-LRTI and 1.82 [95% confidence interval: 1.47–2.24] for influenza). Incidence of all severe IRDs were positively associated with amount of cigarettes smoked. The HRs for each IRD (except influenza) also declined with increasing duration since quitting. Conclusions: Current cigarette smoking was positively associated with higher rates of IRD and the findings extend indications for tobacco control measures and vaccination of current smokers for prevention of severe IRD