Differences in delivery of respiratory treatments by on-call physiotherapists in mechanically ventilated children: a randomised crossover trial

To investigate differences, if any, in the delivery of respiratory treatments to mechanically ventilated children between non-respiratory on-call physiotherapists and specialist respiratory physiotherapists

Catastrophizing mediates the relationship between the personal belief in a just world and pain outcomes among chronic pain support group attendees

Health-related research suggests the belief in a just world can act as a personal resource that protects against the adverse effects of pain and illness. However, currently, little is known about how this belief, particularly in relation to one’s own life, might influence pain. Consistent with the suggestions of previous research, the present study undertook a secondary data analysis to investigate pain catastrophizing as a mediator of the relationship between the personal just world belief and chronic pain outcomes in a sample of chronic pain support group attendees. Partially supporting the hypotheses, catastrophizing was negatively correlated with the personal just world belief and mediated the relationship between this belief and pain and disability, but not distress. Suggestions for future research and intervention development are made

The Thousand-Pulsar-Array programme on MeerKAT – VIII. The subpulse modulation of 1198 pulsars

We report on the subpulse modulation properties of 1198 pulsars using the Thousand-Pulsar-Array programme on MeerKAT. About 35 per cent of the analysed pulsars exhibit drifting subpulses that are more pronounced towards the death line, consistent with previous studies. We estimate that this common phenomenon is detectable in 60 per cent of the overall pulsar population if high-quality data were available for all. This large study reveals the evolution of drifting subpulses across the pulsar population in unprecedented detail. In particular, we find that the modulation period P3 follows a V-shaped evolution with respect to the characteristic age τc, such that the smallest P3 values, corresponding to the Nyquist period P3 ≃ 2, are found at τc ≃ 107.5 yr. The V-shaped evolution can be interpreted and reproduced if young pulsars possess aliased fast intrinsic P3, which monotonically increase, ultimately achieving a slow unaliased P3. Enhancement of irregularities in intrinsic subpulse modulation by aliasing in small-τc pulsars would explain their observed less well defined P3’s and weaker spectral features. Modelling these results as rotating subbeams, their circulation must slow down as the pulsar evolves. This is the opposite to that expected if circulation is driven by E × B drift. This can be resolved if the observed P3 periodicity is due to a beat between an E × B system and the pulsar period. As a by-product, we identified the correct periods and spin-down rates for 12 pulsars, for which harmonically related values were reported in the literature

A change in the NICE guidelines on antibiotic prophylaxis

Since 2008, NICE clinical guidelines have stated: ‘Antibiotic prophylaxis against infective endocarditis is not recommended for people undergoing dental procedures’. This put UK guidance at odds with guidance in the rest of the world, where antibiotic prophylaxis is recommended for patients at high-risk of infective endocarditis undergoing invasive dental procedures. Many dentists also felt this wording prohibited the use of antibiotic prophylaxis, regardless of the wishes of the patient or their personal risk of infective endocarditis and made it difficult for them to use their clinical judgment to deliver individualised care in the best interests of their patients. NICE have now changed this guidance to ‘Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.’ This article examines the implications of this small but important change

The Thousand Pulsar Array program on MeerKAT – IX. The time-averaged properties of the observed pulsar population

We present the largest single survey to date of average profiles of radio pulsars, observed and processed using the same telescope and data reduction software. Specifically, we present measurements for 1170 pulsars, observed by the Thousand Pulsar Array programme at the 64-dish SARAO MeerKAT radio telescope, in a frequency band from 856 to 1712 MHz. We provide rotation measures (RM), dispersion measures, flux densities, and polarization properties. The catalogue includes 254 new RMs that substantially increase the total number of known pulsar RMs. Our integration times typically span over 1000 individual rotations per source. We show that the radio (pseudo-) luminosity has a strong, shallow dependence on the spin-down energy, proportional to Ė0.15±0.04⁠, that contradicts some previous proposals of population synthesis studies. In addition, we find a significant correlation between the steepness of the observed flux density spectra and Ė⁠, and correlations of the fractional linear polarization with Ė⁠, the spectral index, and the pulse width, which we discuss in the context of what is known about pulsar radio emission and how pulsars evolve with time. On the whole, we do not see significant correlations with the estimated surface magnetic field strength, and the correlations with Ė are much stronger than those with the characteristic age. This finding lends support to the suggestion that magnetic dipole braking may not be the dominant factor for the evolution of pulsar rotation over the lifetimes of pulsars. A public data release of the high-fidelity time-averaged pulse profiles in full polarization accompanies our catalogue

Informed consent in veterinary medicine: ethical implications for the profession and the animal 'patient'

Informed consent processes are a vital component of both human and veterinary medicine. Current practice encourages veterinarians to learn from insights in the human medical field about how best to achieve valid consent. However, drawing on published literature in veterinary and medical ethics, this paper identifies considerable differences between the purposes of veterinary and human medical consent. Crucially, it is argued that the legal status of animal patients as ‘property’ has implications for the ethical role of veterinary informed consent and the protection of the animal ‘patient’. It is suggested that veterinary informed consent should be viewed as an ethical pivot point where the multiple responsibilities of a veterinary professional converge. In practice, balancing these responsibilities creates considerable ethical challenges. As an example, the paper discusses the renewed call for UK veterinarians to make animal welfare their first priority; we predict that this imperative may increasingly cause veterinary informed consent to become an ethical pressure point due to tensions caused by the often conflicting interests of animals, owners and the veterinary profession. In conclusion, the paper argues that whilst gaining informed consent can often be presented as a robust ethical justification in human medicine, the same cannot be said in veterinary medicine. If the veterinary profession wish to prioritise animal welfare, there is an urgent need to re-evaluate the nature of authority gained through owner informed consent and to consider whether animal patients might need to be better protected outside the consent process in certain circumstances

Head to head comparisons of two modalities of perfusion adenosine stress echocardiography with simultaneous SPECT

<p>Abstract</p> <p>Background</p> <p>Real-time perfusion (RTP) contrast echocardiography can be used during adenosine stress echocardiography (ASE) to evaluate myocardial ischemia. We compared two different types of RTP power modulation techniques, angiomode (AM) and high-resolution grayscale (HR), with ^99mTc-tetrofosmin single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia.</p> <p>Methods</p> <p>Patients with known or suspected coronary artery disease (CAD), admitted to SPECT, were prospectively invited to participate. Patients underwent RTP imaging (SONOS 5500) using AM and HR during Sonovue^®infusion, before and throughout the adenosine stress, also used for SPECT. Analysis of myocardial perfusion and wall motion by RTP-ASE were done for AM and HR at different time points, blinded to one another and to SPECT. Each segment was attributed to one of the three main coronary vessel areas of interest.</p> <p>Results</p> <p>In 50 patients, 150 coronary areas were analyzed by SPECT and RTP-ASE AM and HR. SPECT showed evidence of ischemia in 13 out of 50 patients. There was no significant difference between AM and HR in detecting ischemia (p = 0.08). The agreement for AM and HR, compared to SPECT, was 93% and 96%, with Kappa values of 0.67 and 0.75, respectively (p < 0.001).</p> <p>Conclusion</p> <p>There was no significant difference between AM and HR in correctly detecting myocardial ischemia as judged by SPECT. This suggests that different types of RTP modalities give comparable data during RTP-ASE in patients with known or suspected CAD.</p