Development and implementation of a decision pathway for general practitioners for the management or referral of suspected allergy.

Many patients with suspected allergy are referred to specialist care inappropriately. We aimed to develop and implement an online decision pathway to aid General Practitioners' (GPs) management decisions in suspected allergy. Our study involved 1487 GPs, 3 referral management centres, 5 GP system suppliers, 4 primary care trusts, and 1 specialist allergy clinic. The pathway was implemented by 3/5 GP system suppliers, published to Map of Medicine and on a specialist clinic website. In the first year, the pathway ranked in the top 10/160 local care maps accessed via Map of Medicine and was viewed 900 times. Only 96 GPs registered to use the clinic website. Only 110 (7%) GPs responded to the feedback request, of which 13/110 (12%) had used the pathway; nearly all thought it useful. It was used by referral management centres as explanation of rejected referrals. Alternative approaches to embed its use are required. Significance for public healthOne in three people in the UK are affected by allergies during their lifetime. Early diagnosis and appropriate management can improve quality of life and reduce emergency hospitalisation. However, referring patients to secondary care is costly in terms of time and resources. We developed a pathway algorithm to support General Practitioners' (GPs) allergy management and referral decisions to ensure that all referrals to specialist clinics were appropriate. The study illustrates a real world implementation with lessons for those seeking to improve the primary-secondary care interface, implementing pathways in various formats. In the UK, Map of Medicine seems to be the most used software. We demonstrated the difficulty of reaching GPs to encourage adoption of online decision support and suggest new ways forward by expanding care pathways into more detailed protocols for use directly by patients

The impact of draping effects on the stiffness and failure behavior of unidirectional non-crimp fabric fiber reinforced composites

Unidirectional non-crimp fabrics (UD-NCF) are often used to exploit the lightweight potential of continuous fiber reinforced plastics (CoFRP). During the draping process, the UD-NCF fabric can undergo large deformations that alter the local fiber orientation, the local fiber volume content (FVC) and create local fiber waviness. Especially the FVC is affected and has a large impact on the mechanical properties. This impact, resulting from different deformation modes during draping, is in general not considered in composite design processes. To analyze the impact of different draping effects on the mechanical properties and the failure behavior of UD-NCF composites, experimental results of reference laminates are compared to the results of laminates with specifically induced draping effects, such as non-constant FVC and fiber waviness. Furthermore, an analytical model to predict the failure strengths of UD laminates with in-plane waviness is introduced. The resulting stiffness and strength values for different FVC or amplitude to wavelength configurations are presented and discussed. In addition, failure envelopes based on the PUCK failure criterion for each draping effect are derived, which show a clear specific impact on the mechanical properties. The findings suggest that each draping effect leads to a “new fabric” type. Additionally, analytical models are introduced and the experimental results are compared to the predictions. Results indicate that the models provide reliable predictions for each draping effect. Recommendations regarding necessary tests to consider each draping effect are presented. As a further prospect the resulting stiffness and strength values for each draping effect can be used for a more accurate prediction of the structural performance of CoFRP parts

Identifying Priority Areas for Chronic Wasting Disease Surveillance in Montana

Chronic Wasting Disease is a fatal prion disease affecting ungulate species throughout North America.  As of 2013, no CWD positive deer have been found in the state of Montana, however, several surrounding states and provinces have identified multiple cases of the disease.  We used information on mule deer habitat selection, abundance, and locations of CWD cases in surrounding states to identify priority areas in Montana for CWD surveillance. The habitat selection models were based on over 10000 VHF and GPS locations collected from mule deer from 1975-2011, and predicted resource selection function (RSF) values for winter and summer in 5 of the 7 wildlife management regions in the state of Montana. We estimated mule deer density using the aerial survey counts weighted by the value of the RSF for each pixel. High priority areas were those that contained the highest densities of mule deer and were closest to locations with CWD positive deer. This information can be used to inform Montana’s CWD surveillance program for mule deer. We concluded that based on mule deer distribution and movement patterns several mule deer herds in Montana were at risk of coming into contact with deer from known infected herds

Counselling for burnout in Norwegian doctors: one year cohort study

Objective To investigate levels and predictors of change in dimensions of burnout after an intervention for stressed doctors

Combining Hunter Surveys and Territorial Dynamics to Monitor Wolf Pack Abundance and Distribution in Montana

Carnivores are difficult to monitor on large spatial scales. We developed a patch occupancy model (POM) using hunter surveys to monitor gray wolves (Canis lupus) in Montana, and evaluated the ability of these models to provide wildlife managers with a time-and cost-efficient monitoring technique. We used hunter’s sightings of wolves as our index of occupancy and explored how classifying a patch as occupied based on different minimum number of wolves sighted (1,2,3,4, or 5) or different minimum number of hunters sighting wolves (1,2,3,4,or 5) affected results. We also evaluated how our definition of a “patch” influenced the occupancy estimates by creating POMs with 3 different patch sizes that corresponded to the variation in wolf territory sizes in Montana. We ran multiple models with different patch sizes predicting occupancy classified according to different levels of minimum wolf sightings and minimum hunters seeing wolves. We assessed model accuracy by comparing POM estimates to the Montana Fish, Wildlife, and Parks (FWP) minimum wolf pack count. Our preliminary results showed that patch size did not strongly influence occupancy estimates and that a patch should only be identified as occupied if ? 2 to ? 4 hunters each observed ? 2 to ? 4 wolves in that patch. Within this range, FWP’s minimum wolf pack count fell within the 95-percent confidence interval of POM estimates for 33 percent of the models

Direct identification of clinical pathogens from liquid culture media by MALDI-TOF MS analysis

Objectives: We propose using MALDI-TOF MS as a tool for identifying microorganisms directly from liquid cultures after enrichment of the clinical sample in the media, to obtain a rapid microbiological diagnosis and an adequate administration of the antibiotic therapy in a clinical setting. Methods: To evaluate this approach, a series of quality control isolates were grown in thioglycollate (TG) broth and brain heart infusion (BHI) broth and extracted under four different protocols before finally being identified by MALDI-TOF MS. After establishing the best extraction protocol, we validated the method in a total of 300 liquid cultures (150 in TG broth and 150 in BHI broth) of different types of clinical samples obtained from two tertiary Spanish hospitals. Results: The initial evaluation showed that the extraction protocol including a 5 minute sonication step yielded 100% valid identifications, with an average score value of 2.305. In the clinical validation of the procedure, 98% of the microorganisms identified from the TG broth were correctly identified relative to 97% of those identified from the BHI broth. In 24% of the samples analysed, growth by direct sowing was only successful in the liquid medium, and no growth was observed in the direct solid agar cultures. Conclusions: Use of MALDI-TOF MS plus the sonication-based extraction method enabled direct and accurate identification of microorganisms in liquid culture media in 15 minutes, in contrast to the 24 hours of subculture required for conventional identification, allowing the administration of a targeted antimicrobial therapy

Importance Of Recruitment To Accurately Predict The Impacts Of Human-Caused Mortality On Wolf Populations

Reliable analyses can help wildlife managers make good decisions, which are particularly critical for controversial decisions such as wolf (Canis lupus) harvest. Creel and Rotella (2010) recently predicted substantial population declines in Montana wolf populations due to harvest, in contrast to predictions made by Montana Fish, Wildlife and Parks (MFWP). Here we replicate their analyses considering only those years in which field monitoring was consistent, and we consider the effect of annual variation in recruitment on wolf population growth. We also use model selection to evaluate models of recruitment and human-caused mortality rates in wolf populations in the Northern Rocky Mountains. Using data from 27 area-years of intensive wolf monitoring, we show that variation in both recruitment and human-caused mortality affect annual wolf population growth rates and that human-caused mortality rates have increased with the sizes of wolf populations. We also show that either recruitment rates have decreased with population sizes or that the ability of current field resources to document recruitment rates has recently become less successful as the number of wolves in the region has increased. Predictions of wolf population growth in Montana from our top models are consistent with field observations and estimates previously made by MFWP. Familiarity with limitations of raw data helps generate more reliable inferences and conclusions in analyses of publicly-available datasets. Additionally, development of efficient monitoring methods for wolves is a pressing need, so that analyses such as ours will be possible in future years when fewer resources will be available for monitoring

Study of the anticancer properties of optically active titanocene oximato compounds

New water soluble and optically active cyclopentadienyl titanium derivatives [(¿5-C5H5)2Ti{(1R, 4S)-¿ON, (R)NH}Cl] (R = Bn (Benzyl) 1a’, 2-pic (2-picolylamine) 1b’) have been synthesized. The novel compounds along with those previously described [(¿5-C5H5)2Ti{(1S, 4R)-¿ON, (R)NH}Cl] (R = Bn 1a, 2-pic 1b) were evaluated by polarimetry, ultra-violet and circular dichroism spectroscopy. The structure of 1b was determined by single crystal X-ray crystallography and showed a unique terminal monohapto Ti–O disposition of the oximato ligand. All enantiomers have been tested against several cancer cell lines in vitro: prostate PC-3 and DU-145, lung A-549, pancreas MiaPaca-2, colorectal HCT-116, leukemia Jurkat and cervical HeLa. In addition, 1a, 1b and 1b’ were tested against non-tumorigenic prostate RWPE-1 cell line. After 24 h of incubation, 1b and 1b’ were moderately active against Jurkat and A-549 cells. The anti-proliferative effect of titanium compounds on prostate PC-3, DU-145 and RWPE-1 cell lines was also assessed after 72 h of drug exposure. The cytotoxic profile of the enantiomers was similar, exception made for the PC-3 cells, with S, R-isomers exhibiting cytotoxicities 2 to 3 times higher than R, S-compounds. Under these conditions, derivative 1b showed calculated IC50 values better than those of Tacke''s Titanocene-Y (bis-[(p-methoxybenzyl)cyclopentadienyl]titanium(IV) dichloride) on both the prostate PC-3 and DU-145 cells. 1a and 1b cytotoxic behaviour shows certain selectiveness, with activities 2–4 times lower on normal prostate RWPE-1 than on cancer PC-3 cells. Furthermore, 1b produces higher cytotoxicity on prostate PC-3, DU-145 and RWPE-1 cells than the additive dose of titanocene dichloride and pro-ligand b·HCl. Additionally, compound-DNA interactions have been investigated by equilibrium dialysis, Fluorescence Resonance Energy Transfer (FRET) melting assays and viscometric titrations, which suggest that these metal complexes and/or their hydrolysis products bind DNA either in the minor groove or externally

Caffeine Inhibits EGF-Stimulated Trophoblast Cell Motility through the Inhibition of mTORC2 and Akt.

Impaired trophoblast invasion is associated with pregnancy disorders such as early pregnancy loss and preeclampsia. There is evidence to suggest that the consumption of caffeine during pregnancy may increase the risk of pregnancy loss; however, little is known about the direct effect of caffeine on normal trophoblast biology. Our objectives were to examine the effect of caffeine on trophoblast migration and motility after stimulation with epidermal growth factor (EGF) and to investigate the intracellular signaling pathways involved in this process. Primary first-trimester extravillous trophoblasts (EVT) and the EVT-derived cell line SGHPL-4 were used to study the effect of caffeine on EGF-stimulated cellular motility using time-lapse microscopy. SGHPL-4 cells were further used to study the effect of caffeine and cAMP on EGF-stimulated invasion of fibrin gels. The influence of caffeine and cAMP on EGF-stimulated intracellular signaling pathways leading to the activation of Akt were investigated by Western blot analysis. Caffeine inhibits both EGF-stimulated primary EVT and SGHPL-4 cell motility. EGF stimulation activates phosphatidylinositol 3-kinase, and Akt and caffeine inhibit this activation. Although cAMP inhibits both motility and invasion, it does not inhibit the activation of Akt, indicating that the effects of caffeine seen in this study are independent of cAMP. Further investigation indicated a role for mammalian target of rapamycin complex 2 (mTORC2) as a target for the inhibitory effect of caffeine. In conclusion, we demonstrate that caffeine inhibits EGF-stimulated trophoblast invasion and motility in vitro and so could adversely influence trophoblast biology in vivo