A Letter of Consequence: Referral Letters from General Practitioners to Secondary Mental Health Services

The referral letter is a key instrument in moving patients from primary to secondary care services. Consequently, the circumstances in which a referral should be made and its contents have been the subject of clinical guidelines. This article is based on a project that demonstrated that physicians do not adhere to clinical guidelines when referring patients to secondary mental health services. This research supports earlier findings into noncompliance with guidelines by general practitioners (GPs). The authors briefly note possible reasons, which have been the subject of some debate. They also present a content analysis of referral letters to demonstrate the important ways in which they differ from guideline criteria. However, their central argument is that the role of the referral letter in relation to the GP’s repertoire of treatments has not been understood fully. Such understanding implies the need for a reexamination of the support available for GPs

NuSTAR hard X-ray observation of a sub-A class solar flare

We report a NuSTAR observation of a solar microflare, SOL2015-09-01T04. Although it was too faint to be observed by the GOES X-ray Sensor, we estimate the event to be an A0.1 class flare in brightness. This microflare, with only 5 counts per second per detector observed by RHESSI, is fainter than any hard X-ray (HXR) flare in the existing literature. The microflare occurred during a solar pointing by the highly sensitive NuSTAR astrophysical observatory, which used its direct focusing optics to produce detailed HXR microflare spectra and images. The microflare exhibits HXR properties commonly observed in larger flares, including a fast rise and more gradual decay, earlier peak time with higher energy, spatial dimensions similar to the RHESSI microflares, and a high-energy excess beyond an isothermal spectral component during the impulsive phase. The microflare is small in emission measure, temperature, and energy, though not in physical size; observations are consistent with an origin via the interaction of at least two magnetic loops. We estimate the increase in thermal energy at the time of the microflare to be 2.4x10^27 ergs. The observation suggests that flares do indeed scale down to extremely small energies and retain what we customarily think of as "flarelike" properties.Comment: Status: Accepted by the Astrophysical Journal, 2017 July 1

The chemistry of the soyasapogenols

Abstract Not Provided

NuSTAR detection of X-ray heating events in the quiet Sun

The explanation of the coronal heating problem potentially lies in the existence of nanoflares, numerous small-scale heating events occurring across the whole solar disk. In this Letter, we present the first imaging spectroscopy X-ray observations of three quiet Sun flares during the Nuclear Spectroscopic Telescope ARray (NuSTAR) solar campaigns on 2016 July 26 and 2017 March 21, concurrent with the Solar Dynamics Observatory/Atmospheric Imaging Assembly (SDO/AIA) observations. Two of the three events showed time lags of a few minutes between peak X-ray and extreme ultraviolet emissions. Isothermal fits with rather low temperatures in the range 3.2–4.1 MK and emission measures of (0.6–15) × 1044 cm−3 describe their spectra well, resulting in thermal energies in the range (2–6) × 1026 erg. NuSTAR spectra did not show any signs of a nonthermal or higher temperature component. However, as the estimated upper limits of (hidden) nonthermal energy are comparable to the thermal energy estimates, the lack of a nonthermal component in the observed spectra is not a constraining result. The estimated Geostationary Operational Environmental Satellite (GOES) classes from the fitted values of temperature and emission measure fall between 1/1000 and 1/100 A class level, making them eight orders of magnitude fainter in soft X-ray flux than the largest solar flares

Determining the Professional Development Needs of Florida Integrated Pest Management Extension Agents

With agriculture as the second largest economic industry in Florida, the state\u27s Extension agents need subject matter expertise necessary for disseminating the latest in agricultural research information to agricultural producers. Using an exploratory sequential design coupled with a Borich model, we determined the professional development needs of Florida Extension agents working in integrated pest management (IPM). Through our needs assessment, we identified 16 IPM competencies and found that the highest priority relative to needed professional development was for the competency determining pest thresholds. Extension personnel can use the list generated to assess perceptions of importance and ability level regarding IPM competencies among Extension professionals in their states

Microflare Heating of a Solar Active Region Observed with NuSTAR, Hinode/XRT, and SDO/AIA

NuSTAR is a highly sensitive focusing hard X-ray (HXR) telescope and has observed several small microflares in its initial solar pointings. In this paper, we present the first joint observation of a microflare with NuSTAR and Hinode/XRT on 2015 April 29 at ~11:29 UT. This microflare shows heating of material to several million Kelvin, observed in Soft X-rays (SXRs) with Hinode/XRT, and was faintly visible in Extreme Ultraviolet (EUV) with SDO/AIA. For three of the four NuSTAR observations of this region (pre-, decay, and post phases) the spectrum is well fitted by a single thermal model of 3.2-3.5 MK, but the spectrum during the impulsive phase shows additional emission up to 10 MK, emission equivalent to A0.1 GOES class. We recover the differential emission measure (DEM) using SDO/AIA, Hinode/XRT, and NuSTAR, giving unprecedented coverage in temperature. We find the pre-flare DEM peaks at ~3 MK and falls off sharply by 5 MK; but during the microflare's impulsive phase the emission above 3 MK is brighter and extends to 10 MK, giving a heating rate of about $2.5 \times 10^{25}$ erg s$^{-1}$. As the NuSTAR spectrum is purely thermal we determined upper-limits on the possible non-thermal bremsstrahlung emission. We find that for the accelerated electrons to be the source of the heating requires a power-law spectrum of $\delta \ge 7$ with a low energy cut-off $E_{c} \lesssim 7$ keV. In summary, this first NuSTAR microflare strongly resembles much more powerful flares.Comment: Accepted for publication in ApJ. 14 pages with 12 figures and 1 tabl

A Letter of Consequence: Referral Letters from General Practitioners to Secondary Mental Health Services

The referral letter is a key instrument in moving patients from primary to secondary care services. Consequently, the circumstances in which a referral should be made and its contents have been the subject of clinical guidelines. This article is based on a project that demonstrated that physicians do not adhere to clinical guidelines when referring patients to secondary mental health services. This research supports earlier findings into noncompliance with guidelines by general practitioners (GPs). The authors briefly note possible reasons, which have been the subject of some debate. They also present a content analysis of referral letters to demonstrate the important ways in which they differ from guideline criteria. However, their central argument is that the role of the referral letter in relation to the GP’s repertoire of treatments has not been understood fully. Such understanding implies the need for a reexamination of the support available for GPs

Down-regulation of sfrp1 in a mammary epithelial cell line promotes the development of a cd44high/cd24low population which is invasive and resistant to anoikis

<p>Abstract</p> <p>Background</p> <p>The Wnt family of secreted proteins is implicated in the regulation of cell fate during development, as well as in cell proliferation, morphology, and migration. Aberrant activation of the Wnt/β-catenin signaling pathway leads to the development of several human cancers, including breast cancer. Secreted frizzled-related protein 1 (SFRP1) antagonizes this pathway by competing with the Frizzled receptor for Wnt ligands resulting in an attenuation of the signal transduction cascade. Loss of SFRP1 expression is observed in breast cancer, along with several other cancers, and is associated with poor patient prognosis. However, it is not clear whether the loss of SFRP1 expression predisposes the mammary gland to tumorigenesis.</p> <p>Results</p> <p>When SFRP1 is knocked down in a non-malignant immortalized mammary epithelial cell line (76 N TERT), nuclear levels of β-catenin rise and the Wnt pathway is stimulated. The SFRP1 knockdown cells exhibit increased expression of the pro-proliferative Cyclin D1 gene and increased cellular proliferation, undergo a partial epithelial-mesenchymal transition (EMT), are resistant to anchorage-independent cell death, exhibit increased migration, are significantly more invasive, and exhibit a CD24^low/CD44^highcell surface marker expression pattern.</p> <p>Conclusion</p> <p>Our study suggests that loss of SFRP1 allows non-malignant cells to acquire characteristics associated with breast cancer cells.</p

The Physical Activity Resource Assessment (PARA) instrument: Evaluating features, amenities and incivilities of physical activity resources in urban neighborhoods

Background: Neighborhood environment factors may influence physical activity (PA). The purpose of this study was to develop and test a brief instrument to systematically document and describe the type, features, amenities, quality and incivilities of a variety of PA resources. Method: The one-page Physical Activity Resource Assessment (PARA) instrument was developed to assess all publicly available PA resources in thirteen urban lower income, high ethnic minority concentration neighborhoods that surrounded public housing developments (HDs) and four higher income, low ethnic minority concentration comparison neighborhoods. Neighborhoods had similar population density and connectivity. Trained field coders rated 97 PA resources (including parks, churches, schools, sports facilities, fitness centers, community centers, and trails) on location, type, cost, features, amenities, quality and incivilities. Assessments typically took about 10 minutes to complete. Results: HD neighborhoods had a mean of 4.9 PA resources (n = 73) with considerable variability in the type of resources available for each neighborhood. Comparison neighborhoods had a mean of 6 resources (n = 24). Most resources were accessible at no cost (82%). Resources in both types of neighborhoods typically had about 2 to 3 PA features and amenities, and the quality was usually mediocre to good in both types of neighborhoods. Incivilities at PA resources in HD neighborhoods were significantly more common than in comparison neighborhoods. Conclusion: Although PA resources were similar in number, features and amenities, the overall appearance of the resources in HD neighborhoods was much worse as indicated by substantially worse incivilities ratings in HD neighborhoods. The more comprehensive assessment, including features, amenities and incivilities, provided by the PARA may be important to distinguish between PA resources in lower and higher deprivation areas