Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting

BACKGROUND: To assist clinicians and researchers in choosing outcome measures for patients with chronic obstructive pulmonary disease attending routine outpatient clinics, a comparative assessment was undertaken of four questionnaires designed to reflect the patients' perception of their physical and emotional health in terms of their feasibility, validity, reliability, and responsiveness to health change. METHODS: Two condition specific questionnaires, the St George's Respiratory Questionnaire (SGRQ) and Guyatt's Chronic Respiratory Questionnaire (CRQ), and two generic questionnaires, the Short Form-36 Health Survey (SF-36) and Euroqol (EQ), were compared for their discriminative and evaluative properties. Spirometric tests and a walking test were also performed. One hundred and fifty six adults who were clinically judged to have COPD and who attended an outpatient chest clinic were assessed at recruitment and six and 12 months later. Patients were also asked whether their health had changed since their last assessment. RESULTS: Completion rates and consistency between items for dimensions of the SGRQ were lower than for dimensions of the other questionnaires. The distributions of responses were skewed for certain dimensions in all questionnaires except the CRQ. Validity was supported for all instruments insofar as patients' scores were associated with differences in disease severity. The generic questionnaires better reflected other health problems. All instruments were reliable over time. The condition specific questionnaires were more responsive between baseline and first follow up visit but this difference did not persist. While certain dimensions of the SF-36 were responsive to patient perceived changes, this did not apply to the derived single index of the EQ. The rating scale of the EQ, however, provided a quick and easy indicator of change. CONCLUSIONS: Evidence from this study supports the CRQ and the SF-36 as comprehensive outcome measures for patients with longstanding COPD

Abruptio placentae, with special reference to coagulopathy: Two years' experience at Edendale hospital

No Abstract

RNA-viromics reveals diverse communities of soil RNA viruses with the potential to affect grassland ecosystems across multiple trophic levels

The distribution and diversity of RNA viruses in soil ecosystems are largely unknown, despite their significant impact on public health, ecosystem functions, and food security. Here, we characterise soil RNA viral communities along an altitudinal productivity gradient of peat, managed grassland and coastal soils. We identified 3462 viral contigs in RNA viromes from purified virus-like-particles in five soil-types and assessed their spatial distribution, phylogenetic diversity and potential host ranges. Soil types exhibited minimal similarity in viral community composition, but with >10-fold more viral contigs shared between managed grassland soils when compared with peat or coastal soils. Phylogenetic analyses predicted soil RNA viral communities are formed from viruses of bacteria, plants, fungi, vertebrates and invertebrates, with only 12% of viral contigs belonging to the bacteria-infecting Leviviricetes class. 11% of viral contigs were found to be most closely related to members of the Ourmiavirus genus, suggesting that members of this clade of plant viruses may be far more widely distributed and diverse than previously thought. These results contrast with soil DNA viromes which are typically dominated by bacteriophages. RNA viral communities, therefore, have the potential to exert influence on inter-kingdom interactions across terrestrial biomes

Loneliness, social relations and health and wellbeing in deprived communities

There is growing policy concern about the extent of loneliness in advanced societies, and its prevalence among various social groups. This study looks at loneliness among people living in deprived communities, where there may be additional barriers to social engagement including low incomes, fear of crime, poor services and transient populations. The aim was to examine the prevalence of loneliness, and also its associations with different types of social contacts and forms of social support, and its links to self-reported health and wellbeing in the population group. The method involved a cross-sectional survey of 4,302 adults across 15 communities, with the data analysed using multinomial logistic regression controlling for sociodemographics, then for all other predictors within each domain of interest. Frequent feelings of loneliness were more common among those who: had contact with family monthly or less; had contact with neighbours weekly or less; rarely talked to people in the neighbourhood; and who had no available sources of practical or emotional support. Feelings of loneliness were most strongly associated with poor mental health, but were also associated with long-term problems of stress, anxiety and depression, and with low mental wellbeing, though to a lesser degree. The findings are consistent with a view that situational loneliness may be the product of residential structures and resources in deprived areas. The findings also show that neighbourly behaviours of different kinds are important for protecting against loneliness in deprived communities. Familiarity within the neighbourhood, as active acquaintance rather than merely recognition, is also important. The findings are indicative of several mechanisms that may link loneliness to health and wellbeing in our study group: loneliness itself as a stressor; lonely people not responding well to the many other stressors in deprived areas; and loneliness as the product of weak social buffering to protect against stressors

How to Stop (Worrying and Love) the Bubble: Boundary Changing Solutions

We discover that a class of bubbles of nothing are embedded as time dependent scaling limits of previous spacelike-brane solutions. With the right initial conditions, a near-bubble solution can relax its expansion and open the compact circle. Thermodynamics of the new class of solutions is discussed and the relationships between brane/flux transitions, tachyon condensation and imaginary D-branes are outlined. Finally, a related class of simultaneous connected S-branes are also examined.Comment: 47 pages; v2 introduction to Weyl cards added, comments added, references added, typos corrected, matches JHEP versio

Strategic eye movements are used to support object authentication

Authentication is an important cognitive process used to determine whether one’s initial identification of an object is corroborated by additional sensory information. Although authentication is critical for safe interaction with many objects, including food, websites, and valuable documents, the visual orienting strategies used to garner additional sensory data to support authentication remain poorly understood. When reliable visual cues to counterfeit cannot be anticipated, distributing fixations widely across an object’s surface might be useful. However, strategic fixation of specific object-defining attributes would be more efficient and should lead to better authentication performance. To investigate, we monitored eye movements during a repetitive banknote authentication task involving genuine and counterfeit banknotes. Although fixations were distributed widely across the note prior to authentication decisions, preference for hard-to mimic areas and avoidance of easily mimicked areas was evident. However, there was a strong tendency to initially fixate the banknote’s portrait, and only thereafter did eye movement control appear to be more strategic. Those who directed a greater proportion of fixations at hard-to-mimic areas and resisted more easily mimicked areas performed better on the authenticity task. The tendency to deploy strategic fixation improved with experience, suggesting that authentication benefits from precise visual orienting and refined categorisation criteria

The environmental context of the Neolithic monuments on the Brodgar Isthmus, Mainland, Orkney

This work was funded in part by Historic Environment Scotland.The World Heritage Sites of Orkney, Scotland contain iconic examples of Neolithic monumentality that have provided significant information about this period of British prehistory. However, currently, a complete understanding of the sites remains to be achieved. This is, in part, because the monuments lack an adequate context within the broader palaeolandscape. Recent investigations (seismic geophysical survey, microfossil analysis and 14C dating) in and around the Brodgar Isthmus, both onshore and offshore, are used to reconstruct the landscapes at a time when sea-level, climate and vegetation were different to that experienced today. Results show that in the early Neolithic the isthmus between the Ring of Brodgar and Stones of Stenness was broader with a smaller loch to the west. Furthermore this landscape contained sandstone outcrops that would have provided a potential source of stone for monument construction. Microfossil analysis and radiocarbon dates demonstrate that the Loch of Stenness was transformed from freshwater to brackish during the early Neolithic, perhaps immediately preceding construction of the major monuments. Finally, the analysis of our data suggests that sediment influx to the loch shows a tenfold increase coincident with widespread vegetation change that straddles the Mesolithic/Neolithic transition at c. 8 ka cal. B.P. These results provide, for the first time, a landscape context for the Neolithic sites on the isthmus.PostprintPeer reviewe

Density Matrix Functional Calculations for Matter in Strong Magnetic Fields: I. Atomic Properties

We report on a numerical study of the density matrix functional introduced by Lieb, Solovej and Yngvason for the investigation of heavy atoms in high magnetic fields. This functional describes {\em exactly} the quantum mechanical ground state of atoms and ions in the limit when the nuclear charge $Z$ and the electron number $N$ tend to infinity with $N/Z$ fixed, and the magnetic field $B$ tends to infinity in such a way that $B/Z^{4/3}\to\infty$. We have calculated electronic density profiles and ground state energies for values of the parameters that prevail on neutron star surfaces and compared them with results obtained by other methods. For iron at $B=10^{12}$ G the ground state energy differs by less than 2 \% from the Hartree-Fock value. We have also studied the maximal negative ionization of heavy atoms in this model at various field strengths. In contrast to Thomas-Fermi type theories atoms can bind excess negative charge in the density matrix model. For iron at $B=10^{12}$ G the maximal excess charge in this model corresponds to about one electron.Comment: Revtex, 13 pages with 6 eps figures include