Consultation etiquette in general practice: A qualitative study of what makes it different for lay cancer caregivers

Background: It is commonplace for lay caregivers to overlook their own health concerns when supporting someone with advanced cancer. During this time, caregivers’ needs as patients are often marginalised by health professionals, including General Practitioners (GPs), who may miss the breadth of caregivers’ needs by focusing on the practicalities of caregiving. GPs traditionally rely on patients to raise their concerns, and then respond to these concerns, but caregivers as patients may be disinclined to cue their GP. The norms of engagement when caregivers consult their GP are less defined, and how they interact with their GP regarding their own health is under-explored. This sub-study investigates the norms, assumptions and subtleties which govern caregiver-GP consultations, and explores factors affecting their interaction regarding caregivers’ own health concerns. Methods: We conducted semi-structured interviews with six lay caregivers and 19 health professionals in Brisbane, Australia, and analyzed the interview transcripts thematically. Results: Traditional norms of engagement are subjected to assumptions and expectations which caregivers and GPs bring to the consultation. Practice pressures also influence both parties’ capacity and willingness to discuss caregivers’ health. Nonetheless, some GPs monitor caregivers’ health opportunistically. Their interaction is enhanced by the quality of the caregiver-GP relationship and by the GP’s skills. Conclusions: Caregivers are caught in a paradox whereby their health needs may become subsumed by the care recipient’s needs in a setting where patient needs are normally scrutinised and supported. Caregivers may not raise their health concerns with their GP, who instead may need to cue them that it is timely and safe to do so. The routine use of a prompt may help to address caregivers’ needs systematically, but it needs to be complemented by GPs’ desire and capacity to engage with patients in a caregiving role. The potential difference GPs can make to the health of these patients is substantial

Distribution and Movements of the Teshekpuk Caribou Herd 1990–2005: Prior to Oil and Gas Development

Four caribou (Rangifer tarandus grantii) herds calve on the North Slope of Alaska, three of which have been exposed to little or no resource development. We present 15 years of baseline data on the distribution and movements of 72 satellite-collared and 10 GPS-collared caribou from the Teshekpuk caribou herd (TCH) that have had little to no exposure to oil and gas activities. Fixed-kernel home range analyses of collared caribou revealed that calving grounds were concentrated (i.e., 50% kernel utilization distribution) along the northeastern, eastern, and southeastern shores of Teshekpuk Lake. During the postcalving period, 51% and 35% of caribou moved through two constricted zones to the east and west of Teshekpuk Lake, respectively, and accessed insect-relief habitat along the Beaufort Sea coast. During late summer and early fall, TCH caribou were concentrated to the southeast and southwest of Teshekpuk Lake. Although 65% of the Teshekpuk caribou wintered in two areas on the central coastal plain around the village of Atqasuk and south of Teshekpuk Lake, other TCH animals wintered in a great variety of places, including the Seward Peninsula, the eastern and southern Brooks Range, and the Arctic National Wildlife Refuge. We detected an apparent emigration rate of 6.9%. One male and five female TCH caribou joined the breeding populations of the Western Arctic and Central Arctic herds. TCH caribou traveled an average distance of 2348 ± 190 km annually. Movement rates were at a maximum in midsummer, lowest in winter, and intermediate during spring and fall migrations. Restrictions on oil and gas leasing and surface occupancy have been in place to protect calving, migratory corridors, and insect-relief habitat for the TCH, but these protections are likely to be removed. These data will provide a good baseline that can be used to compare predevelopment distribution and movement patterns of TCH caribou to distribution and movement patterns during and after petroleum development.Quatre hardes de caribous (Rangifer tarandus grantii) vêlent sur la côte nord de l’Alaska, dont trois de ces hardes ont été exposées à peu ou pas d’aménagement des ressources. Nous présentons des données de base échelonnées sur 15 ans relativement à la répartition et aux déplacements de 72 caribous dotés d’un collier émetteur par satellite et de 10 caribous munis d’un collier émetteur GPS de la harde de caribous de Teshekpuk (HCT), caribous qui ont été peu ou pas du tout frottés aux activités pétrolières et gazières. L’analyse du noyau fixe des domaines vitaux des caribous à collier a révélé que les lieux de vêlage étaient concentrés (c’est-à-dire 50 % de la répartition de l’utilisation du noyau) le long des côtes nord-est, est et sud-est du lac Teshekpuk. Après la période de vêlage, 51 pour cent et 35 pour cent des caribous se déplaçaient au sein de deux zones de constriction à l’est et à l’ouest du lac Teshekpuk, respectivement, et accédaient un habitat où se trouvait moins d’insectes sur la côte de la mer de Beaufort. Vers la fin de l’été et le début de l’automne, les caribous de la HCT étaient concentrés au sud-est et au sud-ouest du lac Teshekpuk. Bien que 65 pour cent des caribous de Teshekpuk passaient l’hiver dans deux régions de la plaine côtière centrale autour du village d’Atqasuk et au sud du lac Teshekpuk, les autres bêtes de la HCT passaient l’hiver dans divers endroits, dont la péninsule de Seward, les versants est et sud des montagnes de Brooks et la Réserve faunique nationale de l’Arctique. Nous avons détecté un taux d’émigration apparent de 6,9 pour cent. Un caribou mâle et cinq caribous femelles de la HCT ont rejoint les populations de reproduction des hardes de l’ouest et du centre de l’Arctique. En moyenne, le caribou de la HCT parcourait une distance de 2348 ± 190 km annuellement. Les taux de déplacement étaient à leur point le plus élevé au milieu de l’été, tandis qu’ils étaient à leur niveau le plus bas l’hiver et à un niveau intermédiaire pendant les migrations du printemps et de l’automne. Il existe des restrictions en matière de location et d’occupation en surface pour le pétrole et le gaz afin de protéger le vêlage, les corridors de migration et les habitats à faible taux d’insectes pour la HCT, mais il est vraisemblable que ces restrictions soient éliminées. Ces données fourniront une bonne base pour comparer la répartition et les déplacements du caribou de la HCT avant la mise en valeur des ressources à la répartition et aux déplacements du caribou de la HCT pendant et après la mise en valeur pétrolière

Cluster analysis based on biochemical constituents in paprika like chillies (Capsicum annuum L.)

Chillies and paprika like chillies (Capsicum annuum L.) belonging to Solanaceae, is a source of natural colour, widely used in the food industry and is in great demand in the international market. Twenty-four accessions belonging to Indigenous Collections of Byadagi Dabbi (ICBD) and others were analyzed for biochemical constituents from leaf. Biochemical constituents studied were total carbohydrate, starch, reducing sugars, total free amino acids, phenol and protein. The accessions were compared for the isozymes viz., peroxidase, super oxide dismutase and poly phenol oxidase in the leaf, besides, leaf protein using SDS-PAGE. The dendrogram showing the relationship among the accessions for leaf biochemical constituents and colour value of fruits formed six clusters. Colour value ranged from 109 to 353 ASTA units. The accessions ICBD-11 and ICBD-19 possessed highest colour value. Accession ICBD-24 was distinctly different from others. Accessions in each cluster had almost uniform colour value and uniform isozyme profile. The accession ICBD-24 was a Coorg collection and ICBD-11 and ICBD-19 were from Dharwad district of Karnataka. Significant positive correlation was observed between colour value and total free amino acids, total protein, total phenol and polyphenol oxidase in paprika like chillies. &nbsp

Use of satellite telemetry data, GIS, and HTML to create an interactive display of caribou movements

The use of animation clearly reveals the large annual variation in wintering areas and large differences in daily movement rates for this herd. This interactive display can be adapted for school groups, subsistence hunters, the general public, or scientists

Use of satellite telemetry to evaluate movements of caribou within subsistence hunting areas in northern Alaska

Caribou from the Teshekpuk Herd (TH) are an important subsistence resource for residents of Inupiaq villages in northern Alaska. In recent years the use of satellite telemetry has increased the understanding of the herd's annual movements and interactions with other herds. Most caribou of the TH are within the National Petroleum Reserve—Alaska (NPRA) throughout the year. The northeastern portion of NPRA has undergone two lease sales for oil and gas exploration, and lease sales are tentatively scheduled for the central/northwest portion of the NPRA in 2004. During 1990—1999, the movements of 27 caribou from the TH were tracked using satellite collars. We evaluated the proportion of time caribou were available to Inupiaq hunters by incorporating maps depicting subsistence-use areas for each of seven Inupiaq villages, and then examining seasonal and annual movements of caribou relative to those areas. By combining caribou locations with subsistence hunting areas, we were able to explore spatial and temporal patterns in caribou availability to subsistence hunters. This information is useful for managers to set appropriate hunting regulations and for devising sensible alternatives and mitigation of likely petroleum development in NPRA

HH Domain of Alzheimer’s Disease Aβ Provides Structural Basis for Neuronal Binding in PC12 and Mouse Cortical/Hippocampal Neurons

A key question in understanding AD is whether extracellular Aβ deposition of parenchymal amyloid plaques or intraneuronal Aβ accumulation initiates the AD process. Amyloid precursor protein (APP) is endocytosed from the cell surface into endosomes where it is cleaved to produce soluble Aβ which is then released into the brain interstitial fluid. Intraneuronal Aβ accumulation is hypothesized to predominate from the neuronal uptake of this soluble extracellular Aβ rather than from ER/Golgi processing of APP. We demonstrate that substitution of the two adjacent histidine residues of Aβ40 results in a significant decrease in its binding with PC12 cells and mouse cortical/hippocampal neurons. These substitutions also result in a dramatic enhancement of both thioflavin-T positive fibril formation and binding to preformed Aβ fibrils while maintaining its plaque-binding ability in AD transgenic mice. Hence, alteration of the histidine domain of Aβ prevented neuronal binding and drove Aβ to enhanced fibril formation and subsequent amyloid plaque deposition - a potential mechanism for removing toxic species of Aβ. Substitution or even masking of these Aβ histidine residues might provide a new therapeutic direction for minimizing neuronal uptake and subsequent neuronal degeneration and maximizing targeting to amyloid plaques

Systematic KMTNet Planetary Anomaly Search. X. Complete Sample of 2017 Prime-Field Planets

We complete the analysis of planetary candidates found by the KMT AnomalyFinder for the 2017 prime fields that cover $\sim 13\,{\rm deg}^2$. We report 3 unambiguous planets: OGLE-2017-BLG-0640, OGLE-2017-BLG-1275, and OGLE-2017-BLG-1237. The first two of these were not previously identified, while the last was not previously published due to technical complications induced by a nearby variable. We further report that a fourth anomalous event, the previously recognized OGLE-2017-BLG-1777, is very likely to be planetary, although its light curve requires unusually complex modeling because the lens and source both have orbiting companions. One of the 3 unambiguous planets, OGLE-2017-BLG-1275 is the first AnomalyFinder discovery that has a {\it Spitzer} microlens parallax measurement, $\pi_E \sim 0.045\pm0.015$, implying that this planetary system almost certainly lies in the Galactic bulge. In the order listed, the four planetary events have planet-host mass ratios $q$, and normalized projected separations $s$, of $(\log q,s)$ = $(-2.31,0.61)$, $(-2.06,0.63/1.09)$, $(-2.10,1.04)$, and $(-2.86,0.72)$. Combined with previously published events, the 2017 AnomalyFinder prime fields contain 11 unambiguous planets with well-measured $q$ and one very likely candidate, of which 3 are AnomalyFinder discoveries. In addition to these 12, there are three other unambiguous planets with large uncertainties in $q$.Comment: 67 pages, 13 figures, 16 table

We should not be complacent about our population-based public health response to the first influenza pandemic of the 21st century

Background: More than a year after an influenza pandemic was declared in June 2009, the World Health Organization declared the pandemic to be over. Evaluations of the pandemic response are beginning to appear in the public domain. Discussion. We argue that, despite the enormous effort made to control the pandemic, it is now time to acknowledge that many of the population-based public health interventions may not have been well considered. Prior to the pandemic, there was limited scientific evidence to support border control measures. In particular no border screening measures would have detected prodromal or asymptomatic infections, and asymptomatic infections with pandemic influenza were common. School closures, when they were partial or of short duration, would not have interrupted spread of the virus in school-aged children, the group with the highest rate of infection worldwide. In most countries where they were available, neuraminidase inhibitors were not distributed quickly enough to have had an effect at the population level, although they will have benefited individuals, and prophylaxis within closed communities will have been effective. A pandemic specific vaccine will have protected the people who received it, although in most countries only a small minority was vaccinated, and often a small minority of those most at risk. The pandemic vaccine was generally not available early enough to have influenced the shape of the first pandemic wave and it is likely that any future pandemic vaccine manufactured using current technology will also be available too late, at least in one hemisphere. Summary. Border screening, school closure, widespread anti-viral prophylaxis and a pandemic-specific vaccine were unlikely to have been effective during a pandemic which was less severe than anticipated in the pandemic plans of many countries. These were cornerstones of the population-based public health response. Similar responses would be even less likely to be effective in a more severe pandemic. We agree with the recommendation from the World Health Organisation that pandemic preparedness plans need review