Developing clinical decision tools to implement chronic disease prevention and screening in primary care: the BETTER 2 program (building on existing tools to improve chronic disease prevention and screening in primary care).

BackgroundThe Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice (BETTER) trial demonstrated the effectiveness of an approach to chronic disease prevention and screening (CDPS) through a new skilled role of a 'prevention practitioner'(PP). The PP has appointments with patients 40-65 years of age that focus on primary prevention activities and screening of cancer (breast, colorectal, cervical), diabetes and cardiovascular disease and associated lifestyle factors. There are numerous and occasionally conflicting evidence-based guidelines for CDPS, and the majority of these guidelines are focused on specific diseases or conditions; however, primary care providers often attend to patients with multiple conditions. To ensure that high-level evidence guidelines were used, existing clinical practice guidelines and tools were reviewed and integrated into blended BETTER tool kits. Building on the results of the BETTER trial, the BETTER tools were updated for implementation of the BETTER 2 program into participating urban, rural and remote communities across Canada.MethodsA clinical working group consisting of PPs, clinicians and researchers with support from the Centre for Effective Practice reviewed the literature to update, revise and adapt the integrated evidence algorithms and tool kits used in the BETTER trial. These resources are nuanced, based on individual patient risk, values and preferences and are designed to facilitate decision-making between providers across the target diseases and lifestyle factors included in the BETTER 2 program. Using the updated BETTER 2 toolkit, clinicians 1) determine which CDPS actions patients are eligible to receive and 2) develop individualized 'prevention prescriptions' with patients through shared decision-making and motivational interviewing.ResultsThe tools identify the patients' risks and eligible primary CDPS activities: the patient survey captures the patient's health history; the prevention visit form and integrated CDPS care map identify eligible CDPS activities and facilitate decisions when certain conditions are met; and the 'bubble diagram' and 'prevention prescription' promote shared decision-making.ConclusionThe integrated clinical decision-making tools of BETTER 2 provide resources for clinicians and policymakers that address patients' complex care needs beyond single disease approaches and can be adapted to facilitate CDPS in the urban, rural and remote clinical setting.Trial registrationThe registration number of the original RCT BETTER trial was ISRCTN07170460

Ap39, a mitochondria-targeting hydrogen sulfide (H2 s) donor, protects against myocardial reperfusion injury independently of salvage kinase signalling

Background and Purpose H2S protects myocardium against ischaemia-reperfusion injury. This protection may involve the cytosolic reperfusion injury salvage kinase (RISK) pathway, but direct effects on mitochondrial function are possible. Here, we investigated the potential cardioprotective effect of mitochondria-specific H2S donor, AP39, at reperfusion against ischaemia/reperfusion injury. Experimental Approach Anaesthetised rats underwent myocardial (30 min ischaemia/120 min reperfusion) with randomisation to receive interventions prior to reperfusion: vehicle, AP39 (0.01, 0.1, 1 µmol kg-1), or the control compounds AP219 or ADT-OH (1 µmol kg-1). LY294002, L-NAME or ODQ were used to interrogate the involvement of RISK pathway. Myocardial samples harvested 5 minutes after reperfusion were analysed for RISK protein phosphorylation and additional experiments were conducted on isolated cardiac mitochondria to examine the direct mitochondrial effects of AP39. Key Results AP39 exerted dose-dependent infarct size limitation. Inhibition of either PI3K/Akt, eNOS or sGC did not affect the infarct limitation of AP39. Western blot analysis confirmed that AP39 did not induce phosphorylation of Akt, eNOS, GSK-3β or ERK1/2. In isolated subsarcolemmal and interfibrillar mitochondria, AP39 significantly attenuated mitochondrial ROS generation without affecting respiratory complexes I or II. Further, AP39 inhibited mitochondrial permeability transition pore (PTP) opening and co-incubation of mitochondria with AP39 and cyclosporine A induced an additive inhibition of PTP. Conclusion and Implications AP39 protects against reperfusion injury independently of the cytosolic RISK pathway. Cardioprotection could be mediated by inhibiting PTP via cyclophilin D-independent mechanism. Thus, selective delivery of H2S to mitochondria may be therapeutically applicable for harnessing the cardioprotective utility of H2S. This article is protected by copyright. All rights reserved

On the Finite-Temperature Generalization of the C-theorem and the Interplay between Classical and Quantum Fluctuations

The behavior of the finite-temperature C-function, defined by Neto and Fradkin [Nucl. Phys. B {\bf 400}, 525 (1993)], is analyzed within a d -dimensional exactly solvable lattice model, recently proposed by Vojta [Phys. Rev. B {\bf 53}, 710 (1996)], which is of the same universality class as the quantum nonlinear O(n) sigma model in the limit $n\to \infty$. The scaling functions of C for the cases d=1 (absence of long-range order), d=2 (existence of a quantum critical point), d=4 (existence of a line of finite temperature critical points that ends up with a quantum critical point) are derived and analyzed. The locations of regions where C is monotonically increasing (which depend significantly on d) are exactly determined. The results are interpreted within the finite-size scaling theory that has to be modified for d=4. PACS number(s): 05.20.-y, 05.50.+q, 75.10.Hk, 75.10.Jm, 63.70.+h, 05.30-d, 02.30Comment: 15 pages LATEX, ioplppt.sty file used, 6 EPS figures. Some changes made in section V (on finite-size scaling interpretation of the results obtained

A Protocol for Messaging to Extraterrestrial Intelligence

Messaging to extraterrestrial intelligence (METI) is a branch of study concerned with constructing and broadcasting a message toward habitable planets. Since the Arecibo message of 1974, the handful of METI broadcasts have increased in content and complexity, but the lack of an established protocol has produced unorganized or cryptic messages that could be difficult to interpret. Here we outline the development of a self-consistent protocol for messaging to extraterrestrial intelligence that provides constraints and guidelines for the construction of a message in order to maximize the probability that the message effectively communicates. A METI protocol considers several factors including signal encoding, message length, information content, anthropocentrism, transmission method, and transmission periodicity. Once developed, the protocol will be released for testing on different human groups worldwide and across cultural boundaries. An effective message to extraterrestrials should at least be understandable by humans, and releasing the protocol for testing will allow us to improve the protocol and develop potential messages. Through an interactive website, users across the world will be able to create and exchange messages that follow the protocol in order to discover the types of messages better suited for cross-cultural communication. The development of a METI protocol will serve to improve the quality of messages to extraterrestrials, foster international collaboration, and extend astrobiology outreach to the public.Comment: Accepted for publication in Space Polic

Hamerkop (Scopus umbretta) predation on an Augrabies flat lizard (Platysaurus broadleyi)

CITATION: Baxter-Gilbert, J. et al. 2019. Hamerkop (Scopus umbretta) predation on an Augrabies flat lizard (Platysaurus broadleyi). The Herpetological Bulletin, 148: 37-38. doi:10.33256/hb148.3738The original publication is available at https://www.thebhs.org/publications/the-herpetological-bulletinOn 27 August 2018 at Augrabies Falls National Park (28.5942° S, 20.3381° E) we observed an adult Hamerkop (Scopus umbretta) foraging adjacent to the main waterfall along a rock shelf midway down the cliff-side. At 15:37 h we saw the bird capturing and swallowing an Augrabies flat lizard (Platysaurus broadleyi; Fig. 1). This observation is noteworthy as to date the primary predators of Augrabies flat lizards are known to be raptors (e.g. Rock Kestrel, Falco rupicolus, and Booted Eagles, Aquila pennatus) and sand snakes (Psammophis sp.), with other potential predators being mongooses and large arthropods, such as spiders and centipedes (Whiting, 2002; A. Jenkins pers. comm.). Hamerkop, to the best of our knowledge, have not been documented previously to consume reptiles, and as such there have been no previous observations of them eating this specific lizard species. The known diet of Hamerkop consists of frogs, particularly of the genus Xenopus, insects, and fish (Skead, 1953; Liversidge, 1963; Dean & MacDonald, 1981; Kahl, 1987; Yohannes, et al., 2014).https://www.thebhs.org/publications/the-herpetological-bulletin/issue-number-148-summer-2019/1949-10-hamerkop-i-scopus-umbretta-i-predation-on-an-augrabies-flat-lizard-i-platysaurus-broadleyi-ihttps://www.thebhs.org/publications/the-herpetological-bulletin/issue-number-148-summer-2019/1949-10-hamerkop-i-scopus-umbretta-i-predation-on-an-augrabies-flat-lizard-i-platysaurus-broadleyi-iPublishers versio

Nurses\u27 Alumnae Association Bulletin, June 1965

President\u27s Page Officers and Committee Chairmen Financial Report Hospital and School of Nursing Report Student Activities Annual Report Students Activities Annual Report Student Activities Annual Report Jefferson Expansion Program Psychiatric Unit Progress of the Alumnae Association Nightingale Pledge Resume of Alumnae Meetings Nursing Service Staff Association Scholarship Program Sick and Welfare Social Committee Report Bulletin Membership- WHY JOIN? Private Duty Report Annual Giving Report - 1964 PIT Alumnae Day Notes Building Fund Report - 1965 Vital Statistics IN MEMORIAM Class News Affiliated Institutions Notice

Nurses\u27 Alumnae Association Bulletin, June 1964

President\u27s Message Officers and Committee Chairmen Financial Report Hospital and School of Nursing Report Student Activities Jefferson Expansion Program Resume of Alumnae Meetings Staff Nurses Private Duty Social Committee Reports Program Scholarship Bulletin Committee Report Annual Luncheon Notes Membership and Dues Units in Jefferson Expansion Program Center Annual Giving Drive 1963 Report of Ways and Means Committee Jefferson Building Fund Contributions Annual Giving Contributions 1964 Jefferson Building Fund Report Help the Building Fund Committee! Vital Statistics Class News Notice

Anisotropic Magnetoresistance in Ga1−x_{1-x}Mnx_xAs

We have measured the magnetoresistance in a series of Ga$_{1-x}$Mn$_x$As samples with 0.033$\le x \le$ 0.053 for three mutually orthogonal orientations of the applied magnetic field. The spontaneous resistivity anisotropy (SRA) in these materials is negative (i.e. the sample resistance is higher when its magnetization is perpendicular to the measuring current than when the two are parallel) and has a magnitude on the order of 5% at temperatures near 10K and below. This stands in contrast to the results for most conventional magnetic materials where the SRA is considerably smaller in magnitude for those few cases in which a negative sign is observed. The magnitude of the SRA drops from its maximum at low temperatures to zero at T$_C$ in a manner that is consistent with mean field theory. These results should provide a significant test for emerging theories of transport in this new class of materials.Comment: 4 pages with 4 figures. Submitted to Physical Review

Patient Frailty: Key Considerations, Definitions and Practical Implications

By 2020, the elderly (≥65-year-old) world population is projected to exceed one billion individuals. This demographic megatrend has brought topics such as physiological age and frailty to the forefront of medical research efforts around the globe. The concept of frailty has evolved significantly since the mid-twentieth century. The outdated stereotype of a “thin, stooped, slow octogenarian” has transitioned to a more scientific and objective understanding of the problem. Still, a comprehensive and concise definition of “frailty” remains elusive. Until such a definition is firmly established and universally agreed upon, clinicians continue to rely on the somewhat subjective conceptual framework of today. In this chapter, the authors review key issues pertaining to clinical management of frail patients, including diagnosis/identification, preventive strategies, therapeutic approaches, and common pitfalls. The relationship between frailty, various domains of life, and functional status is also discussed. Finally, we will touch upon the concepts of end-of-life and goals of care, focusing on their relationship to frailty

Impacts of organic and conventional crop management on diversity and activity of free-living nitrogen fixing bacteria and total bacteria are subsidiary to temporal effects

A three year field study (2007-2009) of the diversity and numbers of the total and metabolically active free-living diazotophic bacteria and total bacterial communities in organic and conventionally managed agricultural soil was conducted at the Nafferton Factorial Systems Comparison (NFSC) study, in northeast England. The result demonstrated that there was no consistent effect of either organic or conventional soil management across the three years on the diversity or quantity of either diazotrophic or total bacterial communities. However, ordination analyses carried out on data from each individual year showed that factors associated with the different fertility management measures including availability of nitrogen species, organic carbon and pH, did exert significant effects on the structure of both diazotrophic and total bacterial communities. It appeared that the dominant drivers of qualitative and quantitative changes in both communities were annual and seasonal effects. Moreover, regression analyses showed activity of both communities was significantly affected by soil temperature and climatic conditions. The diazotrophic community showed no significant change in diversity across the three years, however, the total bacterial community significantly increased in diversity year on year. Diversity was always greatest during March for both diazotrophic and total bacterial communities. Quantitative analyses using qPCR of each community indicated that metabolically active diazotrophs were highest in year 1 but the population significantly declined in year 2 before recovering somewhat in the final year. The total bacterial population in contrast increased significantly each year. Seasonal effects were less consistent in this quantitative study