Using public engagement and consultation to inform the development of ageing-and dementia-friendly pharmacies – Innovative practice

This study explored public perceptions about the importance of, and how to create, ageing- and dementia-friendly pharmacists and pharmacies. In September 2016, four focus groups (45 minutes each) were conducted with 16 participants who represented organisations, groups or forums working with and/or for older people and people with dementia in Greater London. Discussions were recorded via handwritten notes and thematically analysed. Participants confirmed the importance of pharmacists and pharmacies being ageing- and dementia-friendly and described variability in whether this is currently the case. Suggested strategies for improvement included targeting communication, pharmacist leadership and shop layout

Pharmacotherapy for neonatal seizures: current knowledge and future perspectives

Seizures are the most common neurological emergencies in the neonatal period and are associated with poor neurodevelopmental outcomes. Seizures affect up to five per 1000 term births and population-based studies suggest that they occur even more frequently in premature infants. Seizures are a sign of an underlying cerebral pathology, the most common of which is hypoxic-ischaemic encephalopathy in term infants. Due to a growing body of evidence that seizures exacerbate cerebral injury, effective diagnosis and treatment of neonatal seizures is of paramount importance to reduce long-term adverse outcomes. Electroencephalography is essential for the diagnosis of seizures in neonates due to their subtle clinical expression, non-specific neurological presentation and a high frequency of electro-clinical uncoupling in the neonatal period. Hypoxic-ischaemic encephalopathy may require neuroprotective therapeutic hypothermia, accompanying sedation with opioids, anticonvulsant drugs or a combination of all of these. The efficacy, safety, tolerability and pharmacokinetics of seven anticonvulsant drugs (phenobarbital, phenytoin, levetiracetam, lidocaine, midazolam, topiramate and bumetanide) are reviewed. This review is focused only on studies reporting electrographically confirmed seizures and highlights the knowledge gaps that exist in optimal treatment regimens for neonatal seizures. Randomised controlled trials are needed to establish a safe and effective treatment protocol for neonatal seizures

Experimental study of fusion neutron and proton yields produced by petawatt-laser-irradiated D2-3He or CD4-3He clustering gases

We report on experiments in which the Texas Petawatt laser irradiated a mixture of deuterium or deuterated methane clusters and helium-3 gas, generating three types of nuclear fusion reactions: D(d, 3He)n, D(d, t)p and 3He(d, p)4He. We measured the yields of fusion neutrons and protons from these reactions and found them to agree with yields based on a simple cylindrical plasma model using known cross sections and measured plasma parameters. Within our measurement errors, the fusion products were isotropically distributed. Plasma temperatures, important for the cross sections, were determined by two independent methods: (1) deuterium ion time-of-flight, and (2) utilizing the ratio of neutron yield to proton yield from D(d, 3He)n and 3He(d, p)4He reactions, respectively. This experiment produced the highest ion temperature ever achieved with laser-irradiated deuterium clusters.Comment: 16 pages, 6 figure

Sensory imagery in craving: From cognitive psychology to new treatments for addiction

Sensory imagery is a powerful tool for inducing craving because it is a key component of the cognitive system that underpins human motivation. The role of sensory imagery in motivation is explained by Elaborated Intrusion (EI) theory. Imagery plays an important role in motivation because it conveys the emotional qualities of the desired event, mimicking anticipated pleasure or relief, and continual elaboration of the imagery ensures that the target stays in mind. We argue that craving is a conscious state, intervening between unconscious triggers and consumption, and summarise evidence that interfering with sensory imagery can weaken cravings. We argue that treatments for addiction can be enhanced by the application of EI theory to maintain motivation, and assist in the management of craving in high-risk situations

A far-IR view of the starburst driven superwind in NGC 2146

NGC 2146, a nearby luminous infrared galaxy (LIRG), presents evidence for outflows along the disk minor axis in all gas phases (ionized, neutral atomic and molecular). We present an analysis of the multi-phase starburst driven superwind in the central 5 kpc as traced in spatially resolved spectral line observations, using far-IR Herschel PACS spectroscopy, to probe the effects on the atomic and ionized gas, and optical integral field spectroscopy to examine the ionized gas through diagnostic line ratios. We observe an increased ~250 km/s velocity dispersion in the [OI] 63 micron, [OIII] 88 micron, [NII] 122 micron and [CII] 158 micron fine-structure lines that is spatially coincident with high excitation gas above and below the disk. We model this with a slow ~200 km/s shock and trace the superwind to the edge of our field of view 2.5 kpc above the disk. We present new SOFIA 37 micron observations to explore the warm dust distribution, and detect no clear dust entrainment in the outflow. The stellar kinematics appear decoupled from the regular disk rotation seen in all gas phases, consistent with a recent merger event disrupting the system. We consider the role of the superwind in the evolution of NGC 2146 and speculate on the evolutionary future of the system. Our observations of NGC 2146 in the far-IR allow an unobscured view of the wind, crucial for tracing the superwind to the launching region at the disk center, and provide a local analog for future ALMA observations of outflows in high redshift systems.Comment: 16 pages, 13 figures, accepted for publication in Ap

Temperature measurements of fusion plasmas produced by petawatt laser-irradiated D2-3He or CD4-3He clustering gases

Two different methods have been employed to determine the plasma temperature in a laser-cluster fusion experiment on the Texas Petawatt laser. In the first, the temperature was derived from time-of-flight data of deuterium ions ejected from exploding D2 or CD4 clusters. In the second, the temperature was measured from the ratio of the rates of two different nuclear fusion reactions occurring in the plasma at the same time: D(d, 3He)n and 3He(d, p)4He. The temperatures determined by these two methods agree well, which indicates that: i) The ion energy distribution is not significantly distorted when ions travel in the disassembling plasma; ii) The kinetic energy of deuterium ions, especially the hottest part responsible for nuclear fusion, is well described by a near-Maxwellian distribution.Comment: 13 pages, 4 figure

Key issues in recruitment to randomised controlled trials with very different interventions: a qualitative investigation of recruitment to the SPARE trial (CRUK/07/011)

<p>Abstract</p> <p>Background</p> <p>Recruitment to randomised controlled trials (RCTs) with very different treatment arms is often difficult. The ProtecT (Prostate testing for cancer and Treatment) study successfully used qualitative research methods to improve recruitment and these methods were replicated in five other RCTs facing recruitment difficulties. A similar qualitative recruitment investigation was undertaken in the SPARE (Selective bladder Preservation Against Radical Excision) feasibility study to explore reasons for low recruitment and attempt to improve recruitment rates by implementing changes suggested by qualitative findings.</p> <p>Methods</p> <p>In Phase I of the investigation, reasons for low levels of recruitment were explored through content analysis of RCT documents, thematic analysis of interviews with trial staff and recruiters, and conversation analysis of audio-recordings of recruitment appointments. Findings were presented to the trial management group and a plan of action was agreed. In Phase II, changes to design and conduct were implemented, with training and feedback provided for recruitment staff.</p> <p>Results</p> <p>Five key challenges to trial recruitment were identified in Phase I: (a) Investigators and recruiters had considerable difficulty articulating the trial design in simple terms; (b) The recruitment pathway was complicated, involving staff across different specialties/centres and communication often broke down; (c) Recruiters inadvertently used 'loaded' terminology such as 'gold standard' in study information, leading to unbalanced presentation; (d) Fewer eligible patients were identified than had been anticipated; (e) Strong treatment preferences were expressed by potential participants and trial staff in some centres. In Phase II, study information (patient information sheet and flowchart) was simplified, the recruitment pathway was focused around lead recruiters, and training sessions and 'tips' were provided for recruiters. Issues of patient eligibility were insurmountable, however, and the independent Trial Steering Committee advised closure of the SPARE trial in February 2010.</p> <p>Conclusions</p> <p>The qualitative investigation identified the key aspects of trial design and conduct that were hindering recruitment, and a plan of action that was acceptable to trial investigators and recruiters was implemented. Qualitative investigations can thus be used to elucidate challenges to recruitment in trials with very different treatment arms, but require sufficient time to be undertaken successfully.</p> <p>Trial Registration</p> <p>CRUK/07/011; <a href="http://www.controlled-trials.com/ISRCTN61126465">ISRCTN61126465</a></p

Electrodynamics of the high‐latitude trough: Its relationship with convection flows and field‐aligned currents

We present a detailed case study of the electrodynamics of a high‐latitude trough observed at ~ 12 UT (~1 MLT) on 8 March 2008 using multiple instruments, including incoherent scattering radar (ISR), GPS total electron content (TEC), magnetometers, and auroral imager. The electron density within the trough dropped as much as 80% within 6 minutes. This trough was collocated with a counterclockwise convection flow vortex, indicating divergent horizontal electric fields and currents. Together with a collocated dark area shown in auroral images, the observations provide strong evidence for an existence of downward field‐aligned currents (FACs) collocated with the high‐latitude trough. This is further supported by assimilative mapping of ionospheric electrodynamics results. In addition, the downward FACs formed at about the same time as a substorm onset and east of the Harang reversal, suggesting it is part of the substorm current wedge. It has long been a puzzle why this type of high‐latitude trough predominantly occurs just east of the Harang reversal in the postmidnight sector. We suggest that the high‐latitude trough is associated with the formation of downward FACs of the substorm current system, which usually occur just east of the Harang reversal. In addition, we find that the ionospheric electron temperature within the high latitude trough decreases in the F region while increasing in the E region. We discuss possible mechanisms responsible for the complex change in electron temperature, such as ion composition change and/or presence of downward FACs. Key Points Multi‐instrument study of the high‐latitude trough electrodynamics Trough is associated with anti‐clockwise flow vortex and substorm downward FACs Complex Te profile observed in the trough and due to downward FACsPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98817/1/jgra50120.pd

Measurement of the plasma astrophysical S factor for the 3He(D, p)4He reaction in exploding molecular clusters

The plasma astrophysical S factor for the 3He(D, p)4He fusion reaction was measured for the first time at temperatures of few keV, using the interaction of intense ultrafast laser pulses with molecular deuterium clusters mixed with 3He atoms. Different proportions of D2 and 3He or CD4 and 3He were mixed in the gas jet target in order to allow the measurement of the cross-section for the 3He(D, p)4He reaction. The yield of 14.7 MeV protons from the 3He(D, p)4He reaction was measured in order to extract the astrophysical S factor at low energies. Our result is in agreement with other S factor parameterizations found in the literature

Dust in Spiral Galaxies: Comparing Emission and Absorption to Constrain Small-Scale and Very Cold Structures

The detailed distribution of dust in the disks of spiral galaxies is important to understanding the radiative transfer within disks, and to measuring overall dust masses if significant quantities of dust are either very opaque or very cold. We address this issue by comparing measures of dust absorption, using the galaxy-overlap technique in the optical, with measures of the dust grains' thermal emission from 50-2000 micron using ISOPHOT on board ISO and SCUBA at the JCMT. We examine three spiral galaxies projected partially in front of E/S0 galaxies --- AM1316-241, NGC 5545, and NGC 5091 (for NGC 5091 we have only optical and ISO data). Adopting an empirical exponential model for the dust distribution, we compare column densities and dust masses derived from the absorption and emission techniques. This comparison is sensitive to the amount of dust mass in small, opaque structures, which would not contribute strongly to area-weighted absorption measures, and to very cold dust, which would contribute to optical absorption but provide only a small fraction of the sub-mm emission. In AM1316-241, we find global dust masses of 2-5 x 10^7 M_solar, both techniques agreeing at the 50% level. NGC 5545 has about half this dust mass. The concordance of dust masses is well within the errors expected from our knowledge of the radial distribution of dust, and argues against any dominant part of the dust mass being so cold or opaque. The 50-2000 micron data are well fitted by modified Planck functions with an emissivity law beta=-2, at 21 +/- 2 K. We also present 12 micron ISOCAM observations of these pairs.Comparison of H-alpha and 12 micron images of NGC 5545 indicate that ISOCAM images are reliable tracers of star formation.Comment: 16 pages, 4 tables, 8 figures, in press for October Astronomical Journa