Effect of offering different levels of support and free nicotine replacement therapy via an English national telephone quitline: randomised controlled trial

Objective To compare the effects of free nicotine replacement therapy or proactive telephone counselling in addition to standard smoking cessation support offered through a telephone quitline

Anadromy in brown trout (Salmo trutta): A review of the relative roles of genes and environmental factors and the implications for management and conservation

While many brown trout (Salmo trutta) populations spend their entire life cycle in freshwater, especially as river-lake migrants or river residents, others show facultative anadromy. That is, some trout migrate to sea while other individuals of the same population remain within their natal river. Sea trout can give rise to resident offspring and vice versa, although there is a strong tendency to track the parental life history. Anadromy delivers better feeding and thus larger size, which results in higher fecundity in females, enhanced mate choice, and other reproductive benefits. River residence, more prevalent in males as anadromy conveys fewer benefits, can give higher survival and avoids the energy expenditure required by anadromy. Overall, the costs and benefits of anadromy versus residency, measured in terms of survival and reproduction, are finely balanced and small changes to the cost-benefit equation can lead to evolutionary changes in life history. The decision to be anadromous or resident is a quantitative threshold trait, controlled by multiple genes and environmental factors. The dichotomous nature of the trait is postulated to be the result of the environmentally influenced physiological condition (e.g. energy status) relative to a genetically determined threshold. Anadromy ensues when an individual’s condition fails to meet the threshold level, which varies between sexes and among individuals and populations. Environmental factors and genetic architecture may also directly influence life history, e.g., by altering gene expression. A strong genetic influence on the anadromy decision means that facultative anadromy can be altered by natural selection driven by changes such as differential exploitation, stocking with farm-reared brown trout, partial barriers to migration, and changes in climate, and freshwater and marine productivity, together with parasite, pathogen and predator abundance resulting in reduced marine survival and growth. Further studies of the factors determining life history choice, together with multiple population estimates of heritability and differential reproductive success (fitness), are required to understand fully the impact of natural and anthropogenic environmental changes on sea trout dynamics

Can Surgical Trainees Achieve Arthroscopic Competence at the End of Training Programs? A Cross-sectional Study Highlighting the Impact of Working Time Directives.

PURPOSE: To provide training guidance on procedure numbers by assessing how the number of previously performed arthroscopic procedures relate to both competent and expert performance in simulated arthroscopic shoulder tasks. METHODS: A cross-sectional study that assessed simulated shoulder arthroscopic performance was undertaken. A total of 45 participants of varying experience performed 2 validated tasks: a simple diagnostic task and a more complex Bankart labral repair task. All participants provided logbook numbers for previously performed arthroscopies. Performance was assessed with the Global Rating Scale and motion analysis. Receiver operating characteristic curve analyses were conducted to identify optimum cut points for task proficiency at both "competent" and "expert" levels. RESULTS: Increasing surgical experience resulted in significantly better performance for both tasks as assessed by Global Rating Scale or motion analysis (P < .0001). Receiver operating characteristic curve analyses demonstrated 52 previous arthroscopies were needed to perform to a competent level at the diagnostic task and 248 to be competent at the complex task. To perform at an expert level, 290 and 476 previous arthroscopies, respectively, were needed. CONCLUSIONS: This study provides quantified guidance for arthroscopic training and highlights the positive relationship between arthroscopic case load and arthroscopic competency. We have estimated that the number of arthroscopies required to achieve competency in a basic arthroscopic task exceed those recommended in some countries. These estimates provide useful guidance to those responsible for training program. CLINICAL RELEVANCE: The numbers to achieve competent arthroscopic performance in the assessed simulated tasks exceed what is recommended and what is possible during surgical training programs in some countries

Beltline: A History of the Atlanta Beltline and its Associated Historic Resources

Prepared by the Spring 2006 Preservation Planning Class. This project, developed in a collaborative effort by the Atlanta Urban Design commission and GSU students, was designed to highlight the history of the proposed redevelopment nodes along the Beltline, which is an outer band railroad line encircling the city. The purpose was to identify the significance of the resources therein and their links to Atlanta’s history, providing assistance in the overall development process of the Beltline project.https://scholarworks.gsu.edu/history_heritagepreservation/1003/thumbnail.jp

Albumin versus balanced crystalloid for resuscitation in the treatment of sepsis:A protocol for a randomised controlled feasibility study, “ABC-Sepsis”

BACKGROUND: Patients presenting with suspected sepsis to secondary care often require fluid resuscitation to correct hypovolaemia and/or septic shock. Existing evidence signals, but does not demonstrate, a benefit for regimes including albumin over balanced crystalloid alone. However, interventions may be started too late, missing a critical resuscitation window. METHODS: ABC Sepsis is a currently recruiting randomised controlled feasibility trial comparing 5% human albumin solution (HAS) with balanced crystalloid for fluid resuscitation in patients with suspected sepsis. This multicentre trial is recruiting adult patients within 12 hours of presentation to secondary care with suspected community acquired sepsis, with a National Early Warning Score ≥5, who require intravenous fluid resuscitation. Participants are randomised to 5% HAS or balanced crystalloid as the sole resuscitation fluid for the first 6 hours. OBJECTIVES: Primary objectives are feasibility of recruitment to the study and 30-day mortality between groups. Secondary objectives include in-hospital and 90-day mortality, adherence to trial protocol, quality of life measurement and secondary care costs. DISCUSSION: This trial aims to determine the feasibility of conducting a trial to address the current uncertainty around optimal fluid resuscitation of patients with suspected sepsis. Understanding the feasibility of delivering a definitive study will be dependent on how the study team are able to negotiate clinician choice, Emergency Department pressures and participant acceptability, as well as whether any clinical signal of benefit is detected

Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey

Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate). Of these, 58.3% (n = 56) ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%), group (73%), and individual (54%). Just under half (48%, n = 27) offered nicotine replacement therapy (NRT), 21.4% (n = 12) bupropion; 19.6% (n = 11) varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22) believed that the government focus on four-week quit rates, and 42.9% (14 services) believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care

Emerging communities of child-healthcare practice in the management of long-term conditions such as chronic kidney disease: Qualitative study of parents' accounts

Background: Parents of children and young people with long-term conditions who need to deliver clinical care to their child at home with remote support from hospital-based professionals, often search the internet for care-giving information. However, there is little evidence that the information available online was developed and evaluated with parents or that it acknowledges the communities of practice that exist as parents and healthcare professionals share responsibility for condition management. Methods. The data reported here are part of a wider study that developed and tested a condition-specific, online parent information and support application with children and young people with chronic-kidney disease, parents and professionals. Semi-structured interviews were conducted with 19 fathers and 24 mothers who had recently tested the novel application. Data were analysed using Framework Analysis and the Communities of Practice concept. Results: Evolving communities of child-healthcare practice were identified comprising three components and several sub components: (1) Experiencing (parents making sense of clinical tasks) through Normalising care, Normalising illness, Acceptance & action, Gaining strength from the affected child and Building relationships to formalise a routine; (2) Doing (Parents executing tasks according to their individual skills) illustrated by Developing coping strategies, Importance of parents' efficacy of care and Fear of the child's health failing; and (3) Belonging/Becoming (Parents defining task and group members' worth and creating a personal identity within the community) consisting of Information sharing, Negotiation with health professionals and Achieving expertise in care. Parents also recalled factors affecting the development of their respective communities of healthcare practice; these included Service transition, Poor parent social life, Psycho-social affects, Family chronic illness, Difficulty in learning new procedures, Shielding and avoidance, and Language and cultural barriers. Health care professionals will benefit from using the communities of child-healthcare practice model when they support parents of children with chronic kidney disease. Conclusions: Understanding some of the factors that may influence the development of communities of child-healthcare practice will help professionals to tailor information and support for parents learning to manage their child's healthcare. Our results are potentially transferrable to professionals managing the care of children and young people with other long-term conditions. © 2014 Carolan et al.; licensee BioMed Central Ltd

Local Lyman Break Galaxy Analogs: The Impact of Massive Star-forming Clumps on the Interstellar Medium and the Global Structure of Young, Forming Galaxies

We present HST UV/optical imaging, Spitzer mid-IR photometry, and optical spectroscopy of a sample of 30 low-redshift (z=0.1-0.3) galaxies chosen from SDSS/GALEX to be accurate local analogs of the high-z Lyman Break Galaxies. The Lyman Break Analogs (LBAs) are similar in mass, metallicity, dust, SFR, size and gas velocity dispersion, thus enabling a detailed investigation of processes that are important at high-z. The optical emission line properties of LBAs are also similar to those of LBGs, indicating comparable conditions in their ISM. In the UV, LBAs are characterized by complexes of massive star-forming "clumps", while in the optical they most often show evidence for (post-)mergers/interactions. In 6 cases, we find an extremely massive (>10^9 Msun) compact (R~100 pc) dominant central object (DCO). The DCOs are preferentially found in LBAs with the highest mid-IR luminosities and correspondingly high SFRs (15-100 Msun/yr). We show that the massive SF clumps (including the DCOs) have masses much larger than the nuclear super star clusters seen in normal late type galaxies. However, the DCOs have masses, sizes, and densities similar to the excess-light/central-cusps seen in typical elliptical galaxies with masses similar to the LBA galaxies. We suggest that the DCOs form in present-day examples of the dissipative mergers at high redshift that are believed to have produced the central-cusps in local ellipticals. More generally, the properties of the LBAs are consistent with the idea that instabilities in a gas-rich disk lead to very massive star-forming clumps that eventually coalesce to form a spheroid. We speculate that the DCOs are too young at present to be growing a supermassive black hole because they are still in a supernova-dominated outflow phase.Comment: The Astrophysical Journal, In Press (22 pages, 16 figures). For the full version with high-resolution colour figures, see: http://www.mpa-garching.mpg.de/~overzier/Overzier_LBApaper09.pd