Acceptability of chronic liver disease screening in a UK primary care setting: a qualitative evaluation

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. OBJECTIVES: The increasing incidence of chronic liver disease (CLD) in the UK may be attributed to a rise in preventable risk factors, including hazardous alcohol use and type 2 diabetes. Transient elastography (TE) can rapidly stratify risk of CLD in primary care populations and provide an opportunity to raise patient awareness of risk factors.This study explores patients' experiences of TE screening in a primary care setting. In addition, patient awareness of CLD risk is explored. STUDY DESIGN AND SETTING: This study used a qualitative process evaluation of a community screening pathway for CLD (Nottingham, UK). Participants completed semistructured interviews, which were audio-recorded, transcribed verbatim and analysed thematically. PARTICIPANTS: Twenty adults were purposively recruited 6 months to 2 years after TE screening. Inclusion criteria included (1) hazardous alcohol use, (2) type 2 diabetes and/or (3) persistently elevated liver enzymes without known cause. RESULTS: Undergoing TE in primary care was seen as acceptable to most participants. Hazardous alcohol use was identified as the primary cause of CLD; no participants were aware of metabolic risk factors. TE improved understanding of personal risk factors and prompted contemplation of lifestyle changes across all TE stratifications. However, participants' perceptions of risk were altered by the healthcare providers' communication of TE scores. CONCLUSIONS: High acceptability of TE, regardless of the risk factor, provides strong support for inclusion of TE stratification in primary care. Findings highlight the positive impact of receiving TE on risk awareness. Future clinical iterations should improve the structure and communication of TE results to patients

A Spitzer Space Telescope survey of massive young stellar objects in the G333.2-0.4 giant molecular cloud

The G333 giant molecular cloud contains a few star clusters and H II regions, plus a number of condensations currently forming stars. We have mapped 13 of these sources with the appearance of young stellar objects (YSOs) with the Spitzer Infrared Spectrograph in the SL, SH, and LH modules (5-36 micron). We use these spectra plus available photometry and images to characterize the YSOs. The spectral energy distributions (SEDs) of all sources peak between 35 and 110 micron, thereby showing their young age. The objects are divided into two groups: YSOs associated with extended emission in IRAC band 2 at 4.5 micron (`outflow sources') and YSOs that have extended emission in all IRAC bands peaking at the longest wavelengths (`red sources'). The two groups of objects have distinctly different spectra: All the YSOs associated with outflows show evidence of massive envelopes surrounding the protostar because the spectra show deep silicate absorption features and absorption by ices at 6.0, 6.8, and 15.2 micron. We identify these YSOs with massive envelopes cool enough to contain ice-coated grains as the `bloated' protostars in the models of Hosokawa et al. All spectral maps show ionized forbidden lines and PAH emission features. For four of the red sources, these lines are concentrated to the centres of the maps, from which we infer that these YSOs are the source of ionizing photons. Both types of objects show evidence of shocks, with most of the outflow sources showing a line of [S I] in the outflows and two of the red sources showing the more highly excited [Ne III] and [S IV] lines in outflow regions at some distance from the YSOs. The 4.5 micron emission seen in the IRAC band 2 images of the outflow sources is not due to H2 lines, which are too faint in the 5-10 micron wavelength region to be as strong as is needed to account for the IRAC band 2 emission.Comment: 31 pages and 30 figures in the paper plus 11 figures from the online Supporting Information. To be published in the MNRAS. Version 2 has many small changes (typos, spelling, punctuation) and reordering of the Supporting Information figures to make this version conform to the paper that will be printed in MNRA

Imaging and polarimetry of the dust shells around post-AGB stars

We have completed a polarimetric survey of 46 post-AGB stars which indicates that where an extended circumstellar envelope is seen then it is axisymmetric to some degree. This suggests that all post-AGB envelopes are axisymmetric and that the responsible mechanism must be ubiquitous

The radio structure of Menzel 3

We present the first radio continuum images of the evolved late-type stellar object, Menzel 3 (Mz 3), made with multifrequency observations using the Australia Telescope Compact Array. The maximum resolutions attained are 1, 2, 4 and 7 arcsec. At each frequency investigated, the large-scale radio structure is reminiscent of that seen at infrared and optical wavelengths. In the highest-frequency image of resolution 1 arcsec, the radio brightness distribution is dominated by a compact core emission feature, which we attribute to the ionization of either the last exhalation of the superwind (single progenitor scenario) or to the ongoing stellar wind from a companion (binary scenario). At the higher frequencies investigated, we find that this core ionized outflow is asymmetric, optically thick and has a spectral index consistent with that of thermal emission. The mass loss rate associated with the core emission feature is 7 x 10-5 Msolar yr-1. We discuss this outflow and favour its origin as being due to a companion. Extending from either side of the compact core, at PA ~ 120° with respect to the bipolar axis, we find evidence for wings of emission that may be due to the ionized inner surface of an equatorial collimating disc; this surface has dimensions 7 x 1.5 arcsec2 (8800 x 1900 au2 at 1.3 kpc). We suggest that this feature may be part of the circumbinary accretion disc suggested recently by Kastner et al. We measure low brightness temperatures, which we attribute to there being unresolved condensations on sub-arcsecond scales within the beam size

High-resolution radio structure and optical kinematics of NGC 7027

We present the results of the highest-resolution 18-cm (L-band) radio continuum and optical kinematic studies to date of the young planetary nebula (PN), NGC 7027. We discuss the radio image of NGC 7027 made from combined data from the Multi-Element Radio-Linked Interferometer Network and the Very Large Array. This image is used to derive the distribution of the nebular brightness temperature at this frequency. By combining the 18-cm image with the 6-cm (C-band) image of Bryce et al., two-dimensional distributions of the spectral index between L- and C-bands, C-band optical depth and emission measure are constructed and analysed. In the optical regime, high dispersion, spatially resolved observations at high spectral resolution have been obtained of this PN. The resulting velocity ellipses confirm the inclination of the north of the PN towards the line of sight. A waist feature is seen in the equatorial plane and [SII]6716/6731 Å ratios indicate that a density enhancement exists in this region. The PN equatorial expansion velocity is deprojected and measured as 13 +/- 1 km s-1 from the [OIII]4959 Å emission line. This velocity is used to calculate a revised distance estimate of 650 +/- 100 pc. Using the electron density derived from the [SII] ratio, an ionized mass of 0.005 Msolar is determined. The nature of the bright knot situated to the north-west of the PN is investigated at optical and radio wavelengths. In optical emission lines it is found to be redshifted. It is located in the same region as the position of the peak flux density at 18 cm. It is shown that no evidence of a local density enhancement exists in its environs. It is suggested that the appearance of the knot is due to a temperature effect and its existence is interpreted in terms of a breach in the near side of the PN shell. The existence of a jet, at some stage in the evolution of the PN, is invoked to explain the mechanism by which such a breach may have been created

A radio continuum study of the 'Engraved Hourglass' nebula, MyCn 18

We present the first radio continuum images of the ‘Engraved Hourglass’ planetary nebula (PN) MyCn 18 from multifrequency observations with the Australia Telescope. The radio emission is strongly core-dominated at all frequencies investigated. At the three higher observing frequencies, the radio emission is seen to trace the optically-visible hourglass lobes. In the highest resolution image, the position of peak radio brightness is found in a region which we show to be geometrically off-centre in the same sense as the offset of the ‘central’ star seen in the WFPC2 HST images of Sahai et al. The brightness temperatures measured are surprisingly low and this is interpreted as an effect of beam dilution and nebular clumpiness.We have attempted to separate the contributions to the integrated flux density from the lobes and the core and we present individual plots of the radio spectrum for these regions and also for the total nebular emission. These plots are used to obtain (lower, upper) limits to the turnover frequency of the core and the lobes, which in turn are used to derive (lower, upper) limits to the emission measure, density and ionized mass of the respective regions. Assuming the PN is at a distance of 2.4 kpc, we derive (lower, upper) limits to the total ionized mass of the PN of (0.2, 0.8)Msun

A MERLIN movie of mass-loss from RT Vir

We used MERLIN to observe RT Vir at 22 GHz at six epochs during 10 weeks. The water maser emission comes from a thick expanding shell with an elliptical velocity field. MERLIN has a velocity resolution of 0.1 km s(-1) and milli-arcsecond angular resolution, revealing details within the individual maser clouds, typically 12 mas in diameter spanning 15 velocity channels. The brightest peak doubles in intensity to 800 Jy/beam. Features at velocities close to the stellar velocity show the largest proper motions of similar to 3 mas away from the centre of emission. Some features are seen near the outer limits to the maser shell at early epochs only, but new masers appear close to the inner rim. The variability of individual maser features is not a simple function of the stellar luminosity

Magnetic field in the proto-planetary nebula OH17.7-2.0

We have used radio observations of OH masers in protoplanetary nebula (PPN) candidates to probe the magnetic field structure of these objects. Here we present the first results of our study, concerning the PPN OH17.7-2.0

Characterising Star Formation in the Vela Molecular Ridge

Proposa

Characterising Star Formation in the Vela Molecular Ridge

Proposa