Understanding the Canadian adult CT head rule trial: use of the theoretical domains framework for process evaluation

BACKGROUND: The Canadian CT Head Rule was prospectively derived and validated to assist clinicians with diagnostic decision-making regarding the use of computed tomography (CT) in adult patients with minor head injury. A recent intervention trial failed to demonstrate a decrease in the rate of head CTs following implementation of the rule in Canadian emergency departments. Yet, the same intervention, which included a one-hour educational session and reminders at the point of requisition, was successful in reducing cervical spine imaging rates in the same emergency departments. The reason for the varied effect of the intervention across these two behaviours is unclear. There is an increasing appreciation for the use of theory to conduct process evaluations to better understand how strategies are linked with outcomes in implementation trials. The Theoretical Domains Framework (TDF) has been used to explore health professional behaviour and to design behaviour change interventions but, to date, has not been used to guide a theory-based process evaluation. In this proof of concept study, we explored whether the TDF could be used to guide a retrospective process evaluation to better understand emergency physicians’ responses to the interventions employed in the Canadian CT Head Rule trial. METHODS: A semi-structured interview guide, based on the 12 domains from the TDF, was used to conduct telephone interviews with project leads and physician participants from the intervention sites in the Canadian CT Head Rule trial. Two reviewers independently coded the anonymised interview transcripts using the TDF as a coding framework. Relevant domains were identified by: the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on the behaviour. RESULTS: Eight physicians from four of the intervention sites in the Canadian CT Head Rule trial participated in the interviews. Barriers likely to assist with understanding physicians’ responses to the intervention in the trial were identified in six of the theoretical domains: beliefs about consequences; beliefs about capabilities; behavioural regulation; memory, attention and decision processes; environmental context and resources; and social influences. Despite knowledge that the Canadian CT Head Rule was highly sensitive and reliable for identifying clinically important brain injuries and strong beliefs about the benefits for using the rule, a number of barriers were identified that may have prevented physicians from consistently applying the rule. CONCLUSION: This proof of concept study demonstrates the use of the TDF as a guiding framework to design a retrospective theory-based process evaluation. There is a need for further development and testing of methods for using the TDF to guide theory-based process evaluations running alongside behaviour change intervention trials

Well-to-wheel analysis of direct and indirect use of natural gas in passenger vehicles

AbstractThe abundance of natural gas in the United States because of the number of existing natural gas reserves and the recent advances in extracting unconventional reserves has been one of the main drivers for low natural gas prices. A question arises of what is the optimal use of natural gas as a transportation fuel. Is it more efficient to use natural gas in a stationary power application to generate electricity to charge electric vehicles, compress natural gas for onboard combustion in vehicles, or re-form natural gas into a denser transportation fuel? This study investigates the well-to-wheels energy use and greenhouse gas emissions from various natural gas to transportation fuel pathways and compares the results to conventional gasoline vehicles and electric vehicles using the US electrical generation mix. Specifically, natural gas vehicles running on compressed natural gas are compared against electric vehicles charged with electricity produced solely from natural gas combustion in stationary power plants. The results of the study show that the dependency on the combustion efficiency of natural gas in stationary power can outweigh the inherent efficiency of electric vehicles, thus highlighting the importance of examining energy use on a well-to-wheels basis

An ALMA Early Science survey of molecular absorption lines toward PKS1830-211 -- Analysis of the absorption profiles

We present the first results of an ALMA spectral survey of strong absorption lines for common interstellar species in the z=0.89 molecular absorber toward the lensed blazar PKS1830-211. The dataset brings essential information on the structure and composition of the absorbing gas in the foreground galaxy. In particular, we find absorption over large velocity intervals (gtrsim 100 km/s) toward both lensed images of the blazar. This suggests either that the galaxy inclination is intermediate and that we sample velocity gradients or streaming motions in the disk plane, that the molecular gas has a large vertical distribution or extraplanar components, or that the absorber is not a simple spiral galaxy but might be a merger system. The number of detected species is now reaching a total of 42 different species plus 14 different rare isotopologues toward the SW image, and 14 species toward the NE line-of-sight. The abundances of CH, H2O, HCO+, HCN, and NH3 relative to H2 are found to be comparable to those in the Galactic diffuse medium. Of all the lines detected so far toward PKS1830-211, the ground-state line of ortho-water has the deepest absorption. We argue that ground-state lines of water have the best potential for detecting diffuse molecular gas in absorption at high redshift.Comment: Accepted for publication in A&

Travelling for Umrah:destination attributes, destination image, and post-travel intentions

This paper examines the links between cosmopolitanism, self-identity, and a desire for social interaction perceived destination image and behavioural intentions. A model tested using a sample of 538 Iranian visitors to Mecca for the purpose of Umrah. The result from the structural model suggests that destination attributes influence perceived destination image. Further, such tourists are likely to revisit or recommend Islamic destinations if their experience matches their perceived image of the destination. This implies that, while the religious characteristics of the destination remain important, destination managers cannot disregard the tangential, non-religious attributes of a destination which are crucial in order to satisfy more conventional tourist desires. As such, this study suggests that those managing religious travel destinations should endeavour to foster a welcoming image, where experience, interaction and tolerance are at the forefront of the destination’s offering

BMQ

BMQ: Boston Medical Quarterly was published from 1950-1966 by the Boston University School of Medicine and the Massachusetts Memorial Hospitals

Ancient volcanism on the Moon: Insights from Pb isotopes in the MIL 13317 and Kalahari 009 lunar meteorites

Lunar meteorites provide a potential opportunity to expand the study of ancient (>4000 Ma) basaltic volcanism on the Moon, of which there are only a few examples in the Apollo sample collection. Secondary Ion Mass Spectrometry (SIMS) was used to determine the Pb isotopic compositions of multiple mineral phases (Ca-phosphates, baddeleyite K-feldspar, K-rich glass and plagioclase) in two lunar meteorites, Miller Range (MIL) 13317 and Kalahari (Kal) 009. These data were used to calculate crystallisation ages of 4332 ±2Ma (95% confidence level) for basaltic clasts in MIL 13317, and 4369 ±7Ma (95% confidence level) for the monomict basaltic breccia Kal 009. From the analyses of the MIL 13317 basaltic clasts, it was possible to determine an initial Pb isotopic composition of the protolith from which the clasts originated, and infer a 238U/204Pb ratio (μ-value) of 850 ±130(2σ uncertainty) for the magmatic source of this basalt. This is lower than μ-values determined previously for KREEP-rich (an acronym for K, Rare Earth Elements and P) basalts, although analyses of other lithological components in the meteorite suggest the presence of a KREEP component in the regolith from which the breccia was formed and, therefore, a more probable origin for the meteorite on the lunar nearside. It was not possible to determine a similar initial Pb isotopic composition from the Kal 009 data, but previous studies of the meteorite have highlighted the very low concentrations of incompatible trace elements and proposed an origin on the farside of the Moon. Taken together, the data from these two meteorites provide more compelling evidence for widespread ancient volcanism on the Moon. Furthermore, the compositional differences between the basaltic materials in the meteorites provide evidence that this volcanism was not an isolated or localised occurrence, but happened in multiple locations on the Moon and at distinct times. In light of previous studies into early lunar magmatic evolution, these data also imply that basaltic volcanism commenced almost immediately after Lunar Magma Ocean (LMO) crystallisation, as defined by Nd, Hf and Pb model ages at about 4370Ma

Lipidomics Reveals Reduced Inflammatory Lipid Species and Storage Lipids after Switching from EFV/FTC/TDF to RPV/FTC/TDF: A Randomized Open-Label Trial

HIV and antiretroviral therapy affect lipid metabolism. Lipidomics quantifies several individual species that are overlooked using conventional biochemical analyses, outperforming traditional risk equations. We aimed to compare the plasma lipidomic profile of HIV patients taking efavirenz (EFV) or rilpivirine (RPV). Patients >/= 18 years old on EFV co-formulated with emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) with HIV-RNA /=6 months were randomized to continue EFV/FTC/TDF (n = 14) or switch to RPV/FTC/TDF (n =15). Lipidomic analyses conducted by mass spectrometry (MS) were performed at baseline and after 12 and 24 weeks. OWLiver((R)) Care and OWLiver((R)) tests were performed to estimate the presence of fatty liver disease (NAFLD). No significant differences (83% male, median age 44 years, 6 years receiving EFV/FTC/TDF, CD4(+) count 740 cells/mm(3), TC 207 [57 HDL-C/133 LDL-C] mg/dL, TG 117 mg/dL) were observed between the groups at baseline. Significant reductions in plasma lipids and lipoproteins but increased circulating bilirubin concentrations were observed in patients who switched to RPV/FTC/TDF. Patients on RPV/FTC/TDF showed a decrease in the global amount of storage lipids (-0.137 log2 [fold-change] EFV vs. 0.059 log2 [fold-change] RPV) but an increase in lysophosphatidylcholines (LPCs) and total steroids. Compared with EFV, RPV increased metabolites with anti-inflammatory properties and reduced the repository of specific lipotoxic lipids

INSIG1 influences obesity-related hypertriglyceridemia in humans

In our analysis of a quantitative trait locus (QTL) for plasma triglyceride (TG) levels [logarithm of odds (LOD) = 3.7] on human chromosome 7q36, we examined 29 single nucleotide polymorphisms (SNPs) across INSIG1, a biological candidate gene in the region. Insulin-induced genes (INSIGs) are feedback mediators of cholesterol and fatty acid synthesis in animals, but their role in human lipid regulation is unclear. In our cohort, the INSIG1 promoter SNP rs2721 was associated with TG levels (P = 2 × 10−3 in 1,560 individuals of the original linkage cohort, P = 8 × 10−4 in 920 unrelated individuals of the replication cohort, combined P = 9.9 × 10−6). Individuals homozygous for the T allele had 9% higher TG levels and 2-fold lower expression of INSIG1 in surgical liver biopsy samples when compared with individuals homozygous for the G allele. Also, the T allele showed additional binding of nuclear proteins from HepG2 liver cells in gel shift assays. Finally, the variant rs7566605 in INSIG2, the only homolog of INSIG1, enhances the effect of rs2721 (P = 0.00117). The variant rs2721 alone explains 5.4% of the observed linkage in our cohort, suggesting that additional, yet-undiscovered genes and sequence variants in the QTL interval also contribute to alterations in TG levels in humans

Slogging and Stumbling Toward Social Justice in a Private Elementary School: The Complicated Case of St. Malachy

This case study examines St. Malachy, an urban Catholic elementary school primarily serving children traditionally marginalized by race, class, linguistic heritage, and disability. As a private school, St. Malachy serves the public good by recruiting and retaining such traditionally marginalized students. As empirical studies involving Catholic schools frequently juxtapose them with public schools, the author presents this examination from a different tack. Neither vilifying nor glorifying Catholic schooling, this study critically examines the pursuit of social justice in this school context. Data gathered through a 1-year study show that formal and informal leaders in St. Malachy adapted their governance, aggressively sought community resources, and focused their professional development to build the capacity to serve their increasingly pluralistic student population. The analysis confirms the deepening realization that striving toward social justice is a messy, contradictory, and complicated pursuit, and that schools in both public and private sectors are allies in this pursuit