A mixed-methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease.

PublishedClinical TrialJournal ArticleResearch Support, Non-U.S. Gov'tMindfulness-based interventions can successfully target negative perseverative cognitions such as worry and thought suppression, but their acceptability and effectiveness in people with long-term conditions is uncertain. We therefore pilot tested a six-week meditation and mindfulness intervention in people (n = 40) with diabetes mellitus and coronary heart disease. We used a sequential mixed-methods approach that measured change in worry and thought suppression and qualitatively explored acceptability, feasibility, and user experience with a focus group (n = 11) and in-depth interviews (n = 16). The intervention was highly acceptable, with 90% completing ≥5 sessions. Meditation and mindfulness skills led to improved sleep, greater relaxation, and more-accepting approaches to illness and illness experience. At the end of the six-week meditation course, worry, and thought suppression were significantly reduced. Positive impacts of mindfulness-based interventions on psychological health may relate to acquisition and development of meta-cognitive skills but this needs experimental confirmation.NIHR Collaboration for Leadership in Applied Health Research and Care forGreater Manchester

Development of novel multiplex microsatellite polymerase chain reactions to enable high-throughput population genetic studies of Schistosoma haematobium

© 2015 Webster et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. The attached file is the published version of the article

A Holder Continuous Nowhere Improvable Function with Derivative Singular Distribution

We present a class of functions $\mathcal{K}$ in $C^0(\R)$ which is variant of the Knopp class of nowhere differentiable functions. We derive estimates which establish \mathcal{K} \sub C^{0,\al}(\R) for 0<\al<1 but no $K \in \mathcal{K}$ is pointwise anywhere improvable to C^{0,\be} for any \be>\al. In particular, all $K$'s are nowhere differentiable with derivatives singular distributions. $\mathcal{K}$ furnishes explicit realizations of the functional analytic result of Berezhnoi. Recently, the author and simulteously others laid the foundations of Vector-Valued Calculus of Variations in $L^\infty$ (Katzourakis), of $L^\infty$-Extremal Quasiconformal maps (Capogna and Raich, Katzourakis) and of Optimal Lipschitz Extensions of maps (Sheffield and Smart). The "Euler-Lagrange PDE" of Calculus of Variations in $L^\infty$ is the nonlinear nondivergence form Aronsson PDE with as special case the $\infty$-Laplacian. Using $\mathcal{K}$, we construct singular solutions for these PDEs. In the scalar case, we partially answered the open $C^1$ regularity problem of Viscosity Solutions to Aronsson's PDE (Katzourakis). In the vector case, the solutions can not be rigorously interpreted by existing PDE theories and justify our new theory of Contact solutions for fully nonlinear systems (Katzourakis). Validity of arguments of our new theory and failure of classical approaches both rely on the properties of $\mathcal{K}$.Comment: 5 figures, accepted to SeMA Journal (2012), to appea

Inhaled magnesium sulfate in the treatment of acute asthma.

BACKGROUND: Asthma exacerbations can be frequent and range in severity from mild to life-threatening. The use of magnesium sulfate (MgSO₄) is one of numerous treatment options available during acute exacerbations. While the efficacy of intravenous MgSO₄ has been demonstrated, the role of inhaled MgSO₄ is less clear. OBJECTIVES: To determine the efficacy and safety of inhaled MgSO₄ administered in acute asthma. SPECIFIC AIMS: to quantify the effects of inhaled MgSO₄ I) in addition to combination treatment with inhaled β₂-agonist and ipratropium bromide; ii) in addition to inhaled β₂-agonist; and iii) in comparison to inhaled β₂-agonist. SEARCH METHODS: We identified randomised controlled trials (RCTs) from the Cochrane Airways Group register of trials and online trials registries in September 2017. We supplemented these with searches of the reference lists of published studies and by contact with trialists. SELECTION CRITERIA: RCTs including adults or children with acute asthma were eligible for inclusion in the review. We included studies if patients were treated with nebulised MgSO₄ alone or in combination with β₂-agonist or ipratropium bromide or both, and were compared with the same co-intervention alone or inactive control. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial selection, data extraction and risk of bias. We made efforts to collect missing data from authors. We present results, with their 95% confidence intervals (CIs), as mean differences (MDs) or standardised mean differences (SMDs) for pulmonary function, clinical severity scores and vital signs; and risk ratios (RRs) for hospital admission. We used risk differences (RDs) to analyse adverse events because events were rare. MAIN RESULTS: Twenty-five trials (43 references) of varying methodological quality were eligible; they included 2907 randomised patients (2777 patients completed). Nine of the 25 included studies involved adults; four included adult and paediatric patients; eight studies enrolled paediatric patients; and in the remaining four studies the age of participants was not stated. The design, definitions, intervention and outcomes were different in all 25 studies; this heterogeneity made direct comparisons difficult. The quality of the evidence presented ranged from high to very low, with most outcomes graded as low or very low. This was largely due to concerns about the methodological quality of the included studies and imprecision in the pooled effect estimates. Inhaled magnesium sulfate in addition to inhaled β₂-agonist and ipratropiumWe included seven studies in this comparison. Although some individual studies reported improvement in lung function indices favouring the intervention group, results were inconsistent overall and the largest study reporting this outcome found no between-group difference at 60 minutes (MD -0.3 % predicted peak expiratory flow rate (PEFR), 95% CI -2.71% to 2.11%). Admissions to hospital at initial presentation may be reduced by the addition of inhaled magnesium sulfate (RR 0.95, 95% CI 0.91 to 1.00; participants = 1308; studies = 4; I² = 52%) but no difference was detected for re-admissions or escalation of care to ITU/HDU. Serious adverse events during admission were rare. There was no difference between groups for all adverse events during admission (RD 0.01, 95% CI -0.03 to 0.05; participants = 1197; studies = 2). Inhaled magnesium sulfate in addition to inhaled β₂-agonistWe included 13 studies in this comparison. Although some individual studies reported improvement in lung function indices favouring the intervention group, none of the pooled results showed a conclusive benefit as measured by FEV1 or PEFR. Pooled results for hospital admission showed a point estimate that favoured the combination of MgSO₄ and β₂-agonist, but the confidence interval includes the possibility of admissions increasing in the intervention group (RR 0.78, 95% CI 0.52 to 1.15; participants = 375; studies = 6; I² = 0%). There were no serious adverse events reported by any of the included studies and no between-group difference for all adverse events (RD -0.01, 95% CI -0.05 to 0.03; participants = 694; studies = 5). Inhaled magnesium sulfate versus inhaled β₂-agonistWe included four studies in this comparison. The evidence for the efficacy of β₂-agonists in acute asthma is well-established and therefore this could be considered a historical comparison. Two studies reported a benefit of β₂-agonist over MgSO₄ alone for PEFR and two studies reported no difference; we did not pool these results. Admissions to hospital were only reported by one small study and events were rare, leading to an uncertain result. No serious adverse events were reported in any of the studies in this comparison; one small study reported mild to moderate adverse events but the result is imprecise. AUTHORS' CONCLUSIONS: Treatment with nebulised MgSO₄ may result in modest additional benefits for lung function and hospital admission when added to inhaled β₂-agonists and ipratropium bromide, but our confidence in the evidence is low and there remains substantial uncertainty. The recent large, well-designed trials have generally not demonstrated clinically important benefits. Nebulised MgSO₄ does not appear to be associated with an increase in serious adverse events. Individual studies suggest that those with more severe attacks and attacks of shorter duration may experience a greater benefit but further research into subgroups is warranted.Despite including 24 trials in this review update we were unable to pool data for all outcomes of interest and this has limited the strength of the conclusions reached. A core outcomes set for studies in acute asthma is needed. This is particularly important in paediatric studies where measuring lung function at the time of an exacerbation may not be possible. Placebo-controlled trials in patients not responding to standard maximal treatment, including inhaled β₂-agonists and ipratropium bromide and systemic steroids, may help establish if nebulised MgSO₄ has a role in acute asthma. However, the accumulating evidence suggests that a substantial benefit may be unlikely

Proximal tubule morphology after single nephron obstruction in the rat kidney

Proximal tubule morphology after single nephron obstruction in the rat kidney. This study examined the effects on proximal tubule morphology of blocking single nephrons with paraffin wax for one day, one week, or one month in the rat. Proximal tubule lumens were blocked with a short column of wax using micropuncture. Chronically blocked and control (normal) tubules were fixed by either intravascular or intraluminal perfusion of glutaraldehyde solution. Proximal tubule segments down-stream to the wax block were examined by light and transmission electron microscopy. Intraluminal Alcian blue dye, serial sectioning, and nephron microdissection techniques were used to identify nephrons. One day after obstruction, all proximal tubule cells downstream to the block were injured. Some recovery was seen. S1 and S2 segments showed more severe damage than S3 segments. Alcian blue, which normally is excluded from cells, entered the cytoplasm of some damaged S1-S2 cells. After one week of obstruction, the tubule appeared to have reconstituted itself, but cells were less differentiated than normal. One month after obstruction, blocked tubules were atrophied. Tubule cells were simplified and were surrounded by a thickened basement membrane. The results suggest that prolonged proximal tubule blockade produces injury and atrophy of the proximal tubule probably due to ischemia and interruption of normal reabsorptive activity

q-Newton binomial: from Euler to Gauss

A counter-intuitive result of Gauss (formulae (1.6), (1.7) below) is made less mysterious by virtue of being generalized through the introduction of an additional parameter

Functional and cognitive outcomes after COVID-19 delirium

Purpose: To ascertain delirium prevalence and outcomes in COVID-19. / Methods: We conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. / Results: In 71 patients (mean age 61, 75% men), 31 (42%) had delirium, of which only 12 (39%) had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium − 50 out of 166 points (95% CI − 83 to − 17, p = 0.01). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample. / Conclusions: Our findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium term

The X-ray and radio-emitting plasma lobes of 4C23.56: further evidence of recurrent jet activity and high acceleration energies

New Chandra observations of the giant (0.5 Mpc) radio galaxy 4C23.56 at z = 2.5 show X-rays in a linear structure aligned with its radio emission, but anti-correlated with the detailed radio structure. Consistent with the powerful, high-z giant radio galaxies we have studied previously, X-rays seem to be invariably found where the lobe plasma is oldest even where the radio emission has long since faded. The hotspot complexes seem to show structures resembling the double shock structure exhibited by the largest radio quasar 4C74.26, with the X-ray shock again being offset closer to the nucleus than the radio synchrotron shock. In the current paper, the offsets between these shocks are even larger at 35kpc. Unusually for a classical double (FRII) radio source, there is smooth low surface-brightness radio emission associated with the regions beyond the hotspots (further away from the nucleus than the hotspots themselves), which seems to be symmetric for the ends of both jets. We consider possible explanations for this phenomenon, and conclude that it arises from high-energy electrons, recently accelerated in the nearby radio hotspots that are leaking into a pre-existing weakly-magnetized plasma that are symmetric relic lobes fed from a previous episode of jet activity. This contrasts with other manifestations of previous epochs of jet ejection in various examples of classical double radio sources namely (1) double-double radio galaxies by e.g. Schoenmakers et al, (2) the double-double X-ray/radio galaxies by Laskar et al and (3) the presence of a relic X-ray counter-jet in the prototypical classical double radio galaxy, Cygnus A by Steenbrugge et al. The occurrence of multi-episodic jet activity in powerful radio galaxies and quasars indicates that they may have a longer lasting influence on the on-going structure formation processes in their environs than previously presumed.Comment: Accepted by MNRAS; 6 page

A Nonlinear Hysteretic Model for Automated Prediction of Lung Mechanics during Mechanical Ventilation

Mechanical ventilation (MV) is core intensive care unit (ICU) therapy during the Covid-19 pandemic. Optimising MV care to a specific patient with respiratory failure is difficult due to inter- and intra- patient variability in lung mechanics and condition. The ability to accurately predict patient-specific lung response to a change in MV settings would enable semi-automated care and significantly improve the efficiency of MV monitoring and care. It has particular emphasis when considering MV care required to treat Covid-19 patients, who require longer MV care, where patient-specific care can reduce the time on MV required. This study develops a nonlinear smooth hysteresis loop model (HLM) able to capture the essential lung dynamics in a patient-specific fashion from measured ventilator data, particularly for changes of compliance and infection points of the pressure-volume loop. The automated (no human input) hysteresis loop analysis (HLA) method is applied to identify HLM model parameters, enabling automated digital cloning to create a virtual patient model to accurately predict lung response at a specified positive end expiratory pressure (PEEP) level, as well as in response to the changes of PEEP. The performance of this automated digital cloning approach is assessed using clinical data from 4 patients and 8 recruitment maneuver (RM) arms. Validation results show the HLM-based hysteresis loops identified using HLA match clinical pressure volume loops very well with root-mean-square (RMS) errors less than 2% for all 8 data sets over 4 patients, validating the accuracy of the developed HLM in capturing the essential lung physiology and respiratory behaviours at different patient conditions. More importantly, the patient-specific digital clones at lower PEEP levels accurately predict lung response at higher PEEP levels with predicted peak inspiratory pressure (PIP) errors less than 2% in average. In addition, the resulted additional lung volume Vfrc obtained with PEEP changes are predicted with average absolute difference of 0.025L. The overall results validate the versatility and potential of the developed HLM for delineating changes of nonlinear lung dynamics, and its capability to create a predictive virtual patient with use of HLA for future treatment personalization and optimisation in MV therapy