Evaluating an Employee Health Tobacco Cessation Program for Enhanced Success

Tobacco smoking is the number one cause of preventable death in the US. It increases risk for cardiovascular and respiratory disease, diabetes, and many types of cancer. When contrasted with nonsmoking employees, smokers have a greater amount of lost productivity, as well as cost of health and life insurance claims due to illness. The purpose of this evidence-based project was to identify current smokers and monitor the consistency of their progression through the 5 A’s framework within an employee health clinic. Data was collected over two years and 600 charts were reviewed. After the data was analyzed, it was estimated that 8% of employees smoke and that both asking and advising patients to quit smoking is being completed reliably. However, improvement in the assess, assist, and arrange categories of the 5 A’s is needed. Although utilization of each of the 5 A’s steps is needed for the program’s success, future focus on improving arrange utilization by the Nurse Practitioner (NP) will allow for repeated review of each smoker’s cessation progress and barriers

The interaction between metabolic disease and ageing

Two of the greatest crises that civilisation faces in the 21st century are the predicted rapid increases in the ageing population and levels of metabolic disorders such as obesity and type 2 diabetes. A growing amount of evidence now supports the notion that energy balance is a key determinant not only in metabolism but also in the process of cellular ageing. Much of genetic evidence for a metabolic activity-driven ageing process has come from model organisms such as worms and flies where inactivation of the insulin receptor signalling cascade prolongs lifespan. At its most simplistic, this poses a conundrum for ageing in humans – can reduced insulin receptor signalling really promote lifespan and does this relate to insulin resistance seen in ageing? In higher animals, caloric restriction studies have confirmed a longer lifespan when daily calorie intake is reduced to 60% of normal energy requirement. This suggests that for humans, it is energy excess which is a likely driver of metabolic ageing. Interventions that interfere with the metabolic fate of nutrients offer a potentially important target for delaying biological ageing

Defective antifungal immunity in patients with COVID-19

The COVID-19 pandemic has placed a huge strain on global healthcare and been a significant cause of increased morbidity and mortality, particularly in atrisk populations. This disease attacks the respiratory systems and causes significant immune dysregulation in affected patients creating a perfect opportunity for the development of invasive fungal disease (IFD). COVID-19 infection can instill a significant, poorly regulated pro-inflammatory response. Clinically induced immunosuppression or pro-inflammatory damage to mucosa facilitate the development of IFD and Aspergillus, Mucorales, and Candida infections have been regularly reported throughout the COVID-19 pandemic. Corticosteroids and immune modulators are used in the treatment of COVID-19. Corticosteroid use is also a risk factor for IFD, but not the only reason for IFD in COVID -19 patients. Specific dysregulation of the immune system through functional exhaustion of Natural killer (NK) cells and T cells has been observed in COVID-19 through the expression of the exhaustion markers NK-G2A and PD-1. Reduced fungicidal activity of neutrophils from COVID-19 patients indicates that immune dysfunction/imbalance are important risk factors for IFD. The COVID-19 pandemic has significantly increased the at risk population for IFD. Even if the incidence of IFD is relatively low, the size of this new at-risk population will result in a substantial increase in the overall, annual number of IFD cases. It is important to understand how and why certain patients with COVID-19 developed increased susceptibility to IFD, as this will improve our understanding of risk of IFD in the face of future pandemics but also in a clinical era of increased clinical immuno-suppression/modulation

Parental agency, identity and knowledge: mothers of children with dyslexia

This is a postprint of an article whose final and definitive form has been published in the Oxford Review of Education© 2004 Copyright Taylor & Francis; Oxford Review of Education is available online at http://www.informaworld.comIn this paper we report and analyse findings from part of a two-year evaluation project which focuses on parent-professional communications over the issues of learning difficulties arising from dyslexia. The key concepts in this study are dyslexia friendly schools and parental partnership, which are discussed in the current policy interest in inclusive education and parent partnership. A conceptual framework has been derived from the study which focuses on parental strategies to ensure adequate provision for their children, knowledge about dyslexia and identity, in particular that of the mother of the child with dyslexia. Excerpts from in-depth interviews of parents are then presented to illustrate the framework. The significance of the findings is examined in relation to other studies of parent partnership. Implications for a more inclusive version of extended professionalism are also considered

Dependence on Mincle and Dectin-2 Varies With Multiple Candida Species During Systemic Infection

FUNDING SO was supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (Grant No. 099953/Z/12/Z) and by a Wellcome Trust Cross-Disciplinary Award. NG acknowledges Wellcome Trust support of a Senior Investigator (101873/Z/13/Z), Collaborative (200208/A/15/Z) and Strategic Awards (097377/Z11/Z) and the MRC Centre for Medical Mycology (MR/N006364/2). PT was funded by a Wellcome Trust Investigator Award (107964/Z/15/Z) and the UK Dementia Research Institute. ACKNOWLEDGMENTS We wish to acknowledge the NIH-sponsored Mutant Mouse Regional Resource Center (MMRRC) National System as the source of genetically altered mice (C57BL/6-Clec4et m1. 1C fg /Mmucd 031936-UCD) for use in this study. The mice were produced and deposited to the MMRRC by the Consortium for Functional Glycomics supported by the National Institute of General Medical Sciences (GM62116). We also thank the Microscopy and Histology Core Facility at the University of Aberdeen for expert assistance with TEM.Peer reviewedPublisher PD

A regularisation approach to causality theory for C^{1,1}Lorentzian metrics

We show that many standard results of Lorentzian causality theory remain valid if the regularity of the metric is reduced to C^{1,1}. Our approach is based on regularisations of the metric adapted to the causal structure

Decoherent Histories Quantum Mechanics with One 'Real' Fine-Grained History

Decoherent histories quantum theory is reformulated with the assumption that there is one "real" fine-grained history, specified in a preferred complete set of sum-over-histories variables. This real history is described by embedding it in an ensemble of comparable imagined fine-grained histories, not unlike the familiar ensemble of statistical mechanics. These histories are assigned extended probabilities, which can sometimes be negative or greater than one. As we will show, this construction implies that the real history is not completely accessible to experimental or other observational discovery. However, sufficiently and appropriately coarse-grained sets of alternative histories have standard probabilities providing information about the real fine-grained history that can be compared with observation. We recover the probabilities of decoherent histories quantum mechanics for sets of histories that are recorded and therefore decohere. Quantum mechanics can be viewed as a classical stochastic theory of histories with extended probabilities and a well-defined notion of reality common to all decoherent sets of alternative coarse-grained histories.Comment: 11 pages, one figure, expanded discussion and acknowledgment

Effectiveness of nurse‐led group CBT for hot flushes and night sweats in women with breast cancer: results of the MENOS4 randomised controlled trial

Objective Troublesome hot flushes and night sweats (HFNS) are experienced by many women after treatment for breast cancer, impacting significantly on sleep and quality of life. Cognitive behavioural therapy (CBT) is known to be effective for the alleviation of HFNS. However, it is not known if it can effectively be delivered by specialist nurses. We investigated whether group CBT delivered by breast care nurses (BCNs) can reduce the impact of HFNS.MethodsWe recruited women with primary breast cancer following primary treatment with seven or more HFNS/week (including 4/10 or above on the HFNS problem rating scale), from six UK hospitals to an open, randomised, phase 3 effectiveness trial. Participants were randomised to Group CBT or usual care (UC). The primary endpoint was HFNS problem rating at 26 weeks post randomisation. Secondary outcomes included sleep, depression, anxiety and quality of life. ResultsBetween 2017-2018, 130 participants were recruited (CBT:63, control:67). We found a 46% (6.9 to 3.7) reduction in the mean HFNS problem rating score from randomisation to 26 weeks in the CBT arm and a 15% (6.5 to 5.5) reduction in the UC arm (adjusted mean difference -1.96, CI -3.68 to -0.23, p=0.039). Secondary outcomes, including frequency of HFNS, sleep, anxiety and depression all improved significantly.ConclusionOur results suggest that specialist nurses can be trained to deliver CBT effectively to alleviate troublesome menopausal hot flushes in women following breast cancer in the NHS setting