Qualitative inquiry with persons with obesity about weight management in primary care and referrals

IntroductionReferrals to evidence-based weight management in the community-commercial sector are aligned with clinical recommendations but underutilized.MethodsThis qualitative study explored patients’ perceptions and expectations about obesity treatment in primary care and referral to community-commercial sector programs. Individual semi-structured interviews were conducted with a sample of US persons with obesity via telephone. Audiotape transcripts, interviewer notes, and independent review of data by two investigators allowed for data and investigator triangulation. Transcripts were analyzed using thematic analysis.ResultsData saturation was reached with 30 participants who had a mean age of 41.6 years (SD 9.4), 37% male, 20% Black/African American and 17% Hispanic, 57% college educated, and 50% were employed full-time. Three primary themes emerged: (1) frustration with weight management in primary care; (2) patients expect providers to be better informed of and offer treatment options; and (3) opportunities and challenges with referrals to community-commercial programs.DiscussionPatients expect that providers offer personalized treatment options and referrals to effective community-commercial programs are an acceptable option. If patient-level data are shared between clinical and community entities to facilitate referrals, then privacy and security issues need attention. Future research is needed to determine feasibility of implementing clinical to community-commercial referrals for obesity treatment in the United States

Polarized QPOs from the INTEGRAL polar IGRJ14536-5522 (=Swift J1453.4-5524)

We report optical spectroscopy and high speed photometry and polarimetry of the INTEGRAL source IGRJ14536-5522 (=Swift J1453.4-5524). The photometry, polarimetry and spectroscopy are modulated on an orbital period of 3.1564(1) hours. Orbital circularly polarized modulations are seen from 0 to -18 per cent, unambiguously identifying IGRJ14536-5522 as a polar. Some of the high speed photometric data show modulations that are consistent with quasi-periodic oscillations (QPOs) on the order of 5-6 minutes. Furthermore, for the first time, we detect the (5-6) minute QPOs in the circular polarimetry. We discuss the possible origins of these QPOs. We also include details of HIPPO, a new high-speed photo-polarimeter used for some of our observations.Comment: Accepted for publication by MNRAS. The paper contains 7 figures and 1 tabl

Tidal Modulation of a Lateral Shear Margin: Priestley Glacier, Antarctica

We use high resolution, ground-based observations of ice displacement to investigate ice deformation across the floating left-lateral shear margin of Priestley Glacier, Terra Nova Bay, Antarctica. Bare ice conditions allow us to fix survey marks directly to the glacier surface. A combination of continuous positioning of a local reference mark, and repeat positioning of a network of 33 stakes installed across a 2 km width of the shear margin are used to quantify shear strain rates and the ice response to tidal forcing over an 18-day period. Along-flow velocity observed at a continuous Global Navigation Satellite Systems (GNSS) station within the network varies by up to ∼30% of the mean speed (±28 m a−1) over diurnal tidal cycles, with faster flow during the falling tide and slower flow during the rising tide. Long-term deformation in the margin approximates simple shear with a small component of flow-parallel shortening. At shorter timescales, precise optical techniques allow high-resolution observations of across-flow bending in response to the ocean tide, including across-flow strains on the order of 10–5. An elastodynamic model informed by the field observations is used to simulate the across-flow motion and deformation. Flexure is concentrated in the shear margin, such that a non-homogeneous elastic modulus is implied to best account for the combined observations. The combined pattern of ice displacement and ice strain also depends on the extent of coupling between the ice and valley sidewall. These conclusions suggest that investigations of elastic properties made using vertical ice motion, but neglecting horizontal displacement and surface strain, will lead to incorrect conclusions about the elastic properties of ice and potentially over-simplified assumptions about the sidewall boundary condition

Ultrasonic and seismic constraints on crystallographic preferred orientations of the Priestley Glacier shear margin, Antarctica

Crystallographic preferred orientations (CPOs) are particularly important in controlling the mechanical properties of glacial shear margins. Logistical and safety considerations often make direct sampling of shear margins difficult, and geophysical measurements are commonly used to constrain the CPOs. We present here the first direct comparison of seismic and ultrasonic data with measured CPOs in a polar shear margin. The measured CPO from ice samples from a 58 m deep borehole in the left lateral shear margin of the Priestley Glacier, Antarctica, is dominated by horizontal c axes aligned sub-perpendicularly to flow. A vertical-seismic-profile experiment with hammer shots up to 50 m away from the borehole, in four different azimuthal directions, shows velocity anisotropy of both P waves and S waves. Matching P-wave data to the anisotropy corresponding to CPO models defined by horizontally aligned c axes gives two possible solutions for the c-axis azimuth, one of which matches the c-axis measurements. If both P-wave and S-wave data are used, there is one best fit for the azimuth and intensity of c-axis alignment that matches the measurements well. Azimuthal P-wave and S-wave ultrasonic data recorded in the laboratory on the ice core show clear anisotropy of P-wave and S-wave velocities in the horizontal plane that match that predicted from the CPO of the samples. With quality data, azimuthal increments of 30∘ or less will constrain well the orientation and intensity of c-axis alignment. Our experiments provide a good framework for planning seismic surveys aimed at constraining the anisotropy of shear margins

Microstructure and crystallographic preferred orientations of an azimuthally oriented ice core from a lateral shear margin: Priestley Glacier, Antarctica

A 58 m long azimuthally oriented ice core has been collected from the floating lateral sinistral shear margin of the lower Priestley Glacier, Terra Nova Bay, Antarctica. The crystallographic preferred orientations (CPO) and microstructures are described in order to correlate the geometry of anisotropy with constrained large-scale kinematics. Cryogenic Electron Backscatter Diffraction analysis shows a very strong fabric (c-axis primary eigenvalue ∼0.9) with c-axes aligned horizontally sub-perpendicular to flow, rotating nearly 40° clockwise (looking down) to the pole to shear throughout the core. The c-axis maximum is sub-perpendicular to vertical layers, with the pole to layering always clockwise of the c-axes. Priestley ice microstructures are defined by largely sub-polygonal grains and constant mean grain sizes with depth. Grain long axis shape preferred orientations (SPO) are almost always 1–20° clockwise of the c-axis maximum. A minor proportion of “oddly” oriented grains that are distinct from the main c-axis maximum, are present in some samples. These have horizontal c-axes rotated clockwise from the primary c-axis maximum and may define a weaker secondary maximum up to 30° clockwise of the primary maximum. Intragranular misorientations are measured along the core, and although the statistics are weak, this could suggest recrystallization by subgrain rotation to occur. These microstructures suggest subgrain rotation (SGR) and recrystallization by grain boundary migration recrystallization (GBM) are active in the Priestley Glacier shear margin. Vorticity analysis based on intragranular distortion indicates a vertical axis of rotation in the shear margin. The variability in c-axis maximum orientation with depth indicates the structural heterogeneity of the Priestley Glacier shear margin occurs at the meter to tens of meters scale. We suggest that CPO rotations could relate to rigid rotation of blocks of ice within the glacial shear margin. Rotation either post-dates CPO and SPO development or is occurring faster than CPO evolution can respond to a change in kinematics

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

A new two channel high-speed photo-polarimeter (HIPPO) for the SAAO

We report on the completion of a new 2 channel, HIgh speed Photo-POlarimeter (HIPPO) for the 1.9m optical telescope of the South African Astronomical Observatory. The instrument makes use of rapidly counter-rotating (10Hz), super-achromatic half- and quarter-waveplates, a fixed Glan-Thompson beamsplitter and two photo-multiplier tubes that record the modulated O and E beams. Each modulated beam permits an independent measurement of the polarisation and therefore simultaneous 2 filter observations. All Stokes parameters are recorded every 0.1sec and photometry every 1 millisecond. Post-binning of data is possible in order to improve the signal. This is ideal for measuring e.g. the rapid variability of the optical polarisation from magnetic Cataclysmic Variable stars. First light was obtained in February 2008

The impact of central IRB's on informed consent readability and trial adherence in SPRINT

Federal agencies have encouraged the use of central institutional review boards (CIRBs) for multi-site clinical trials. There is limited evidence supporting the use of CIRBs. Our aim is to evaluate how SPRINT sites regulated by CIRBs performed regarding informed consent readability and participant trial adherence compared to those regulated by local IRBs. We conducted a cohort study using the SPRINT clinical trial. We collected the IRB of record from the stamped and approved 2012 informed consents from each of the sites. We defined CIRB as an IRB for more than one SPRINT site. Our outcomes were informed consent readability measured using the Flesch-Kincaid readability scale and trial adherence defined as a loss to follow-up, consent withdrawal, and missed last 3-month visit. Sixty-one percent of all SPRINT sites used a CIRB as their IRB of record. The adjusted mean grade reading level for CIRB consents was 13.4 (95% CI 12.6–13.8) compared to 12.3 (95% CI 12.1–13.1) for non CIRB consents (p = 0.07). CIRB sites had similar rates of withdrawal of consent and loss to follow-up as non-CIRB sites; subjects missing the last appointment of the study were more likely to come from sites regulated by a CIRB. The Veterans Affairs CIRB had the lowest rate of withdrawal of consent (1.9%) and the lowest rate of missed appointments (1.9%) among CIRBs. Niether CIRB-regulated sites nor IRB regulated sites enforce the recommended readability level of the informed consent documents. Sites regulated by both IRBs had similar participant trial adherence