Beyond the helium buffer: C-12(2)- rotational cooling in cold traps with H-2 as a partner gas: interaction forces and quantum dynamics

The scattering cross-sections and corresponding rate coefficients for rotationally inelastic collisions of 12 C−2 (2Σ+g) with H2 (1Σ+g) are presented over a broad range of cold-trap temperatures. They have been calculated using quantum scattering theory that employs a new ab initio potential energy surface. The rate coefficients for the inelastic processes in the anionic partner are used to model the thermalisation dynamics of 12 C−2 using H2 as a buffer gas, a trap partner which is found here to be far more efficient than the typical buffer gas He and even more so than when using Ar as a partner gas. The microscopic physics underlying these findings is discussed in some detail. We additionally compute and discuss 12 C−2 quadrupole transitions by spontaneous emission and use the newly computed rates to show that the anion's rotational levels should be in local thermal equilibrium at typical interstellar conditions

Vibrational quenching of CN− in collisions with He and Ar

The vibrational quenching cross sections and corresponding low-temperature rate constants for the ν = 1 and ν = 2 states of CN− ( 1Σ + ) colliding with He and Ar atoms have been computed ab initio using new three-dimensional potential energy surfaces. Little work has been carried out so far on low-energy vibrationally inelastic collisions for anions with neutral atoms. The cross sections and rates calculated at energies and temperatures relevant for both ion traps and astrochemical modeling are found by the present calculations to be even smaller than those of the similar C− 2 /He and C− 2 /Ar systems, which are in turn of the order of those existing for the collisions involving neutral diatom–atom systems. The implications of our finding in the present case mainly focus on the possible role of small computed rate constants in the dynamics of molecular cooling and the evolution of astrochemical modeling networks

The diagnostic accuracy of a single CEA blood test in detecting colorectal cancer recurrence: Results from the FACS trial

Objective: To evaluate the diagnostic accuracy of a single CEA (carcinoembryonic antigen) blood test in detecting colorectal cancer recurrence. Background: Patients who have undergone curative resection for primary colorectal cancer are typically followed up with scheduled CEA testing for 5 years. Decisions to investigate further (usually by CT imaging) are based on single test results, reflecting international guidelines. Methods: A secondary analysis was undertaken of data from the FACS trial (two arms included CEA testing). The composite reference standard applied included CT-CAP imaging, clinical assessment and colonoscopy. Accuracy in detecting recurrence was evaluated in terms of sensitivity, specificity, likelihood ratios, predictive values, time-dependent area under the ROC curves, and operational performance when used prospectively in clinical practice are reported. Results: Of 582 patients, 104 (17.9%) developed recurrence during the 5 year follow-up period. Applying the recommended threshold of 5µg/L achieves at best 50.0% sensitivity (95% CI: 40.1-59.9%); in prospective use in clinical practice it would lead to 56 missed recurrences (53.8%; 95% CI: 44.2-64.4%) and 89 false alarms (56.7% of 157 patients referred for investigation). Applying a lower threshold of 2.5µg/L would reduce the number of missed recurrences to 36.5% (95% CI: 26.5-46.5%) but would increase the false alarms to 84.2% (924/1097 referred). Some patients are more prone to false alarms than others – at the 5µg/L threshold, the 89 episodes of unnecessary investigation were clustered in 29 individuals. Conclusion: Our results demonstrated very low sensitivity for CEA, bringing to question whether it could ever be used as an independent triage test. It is not feasible to improve the diagnostic performance of a single test result by reducing the recommended action threshold because of the workload and false alarms generated. Current national and international guidelines merit re-evaluation and options to improve performance, such as making clinical decisions on the basis of CEA trend, should be further assessed

Hydrogen molecule-antihydrogen atom potential energy surface and scattering calculations

We are grateful for helpful discussions with Edward Armour, Martin Plummer and Gleb Gribakin. This work was supported by the UK Engineering and Physical Sciences Research Council (EPSRC) via a Doctoral Training Account studentship for BPM, grant number EP/K502960/1. The contribution of KS was financed by the statutory activity subsidy from the Polish Ministry of Science and Higher Education for the Faculty of Chemistry of Wrocław University of Science and Technology (contract number 0401/0121/18). We thank the EPSRC-funded CCPQ consortium and the Royal Society of Chemistry for further financial support. We also thank the referees for their comments on the manuscript.Peer reviewedPublisher PD

An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial

Objective To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae. Design Pragmatic, parallel group, cluster randomised controlled trial. Setting 228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom. Participants 1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012. Intervention Targeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment. Main outcome measures Primary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points. Results 64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval −0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. Conclusions This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies

Analyzing Recent Coronary Heart Disease Mortality Trends in Tunisia between 1997 and 2009.

BACKGROUND: In Tunisia, Cardiovascular Diseases are the leading causes of death (30%), 70% of those are coronary heart disease (CHD) deaths and population studies have demonstrated that major risk factor levels are increasing. OBJECTIVE: To explain recent CHD trends in Tunisia between 1997 and 2009. METHODS: DATA SOURCES: Published and unpublished data were identified by extensive searches, complemented with specifically designed surveys. ANALYSIS: Data were integrated and analyzed using the previously validated IMPACT CHD policy model. Data items included: (i)number of CHD patients in specific groups (including acute coronary syndromes, congestive heart failure and chronic angina)(ii) uptake of specific medical and surgical treatments, and(iii) population trends in major cardiovascular risk factors (smoking, total cholesterol, systolic blood pressure (SBP), body mass index (BMI), diabetes and physical inactivity). RESULTS: CHD mortality rates increased by 11.8% for men and 23.8% for women, resulting in 680 additional CHD deaths in 2009 compared with the 1997 baseline, after adjusting for population change. Almost all (98%) of this rise was explained by risk factor increases, though men and women differed. A large rise in total cholesterol level in men (0.73 mmol/L) generated 440 additional deaths. In women, a fall (-0.43 mmol/L), apparently avoided about 95 deaths. For SBP a rise in men (4 mmHg) generated 270 additional deaths. In women, a 2 mmHg fall avoided 65 deaths. BMI and diabetes increased substantially resulting respectively in 105 and 75 additional deaths. Increased treatment uptake prevented about 450 deaths in 2009. The most important contributions came from secondary prevention following Acute Myocardial Infarction (AMI) (95 fewer deaths), initial AMI treatments (90), antihypertensive medications (80) and unstable angina (75). CONCLUSIONS: Recent trends in CHD mortality mainly reflected increases in major modifiable risk factors, notably SBP and cholesterol, BMI and diabetes. Current prevention strategies are mainly focused on treatments but should become more comprehensive

Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review

Objective To determine the relative accuracy of clinic measurements and home blood pressure monitoring compared with ambulatory blood pressure monitoring as a reference standard for the diagnosis of hypertension

CoForTips Congo basin forests: tipping points for biodiversity conservation and resilience. Final Report (La modélisation des changements d’utilisation des terres dans les pays d’Afrique Centrale 2000-2030)

L'utilisation des terres est un facteur crucial pour le développement économique et l'environnement. Ainsi une terre dédiée à l’agriculture permettra une production régulière qui sera bénéfique pour satisfaire les besoins alimentaires des populations alentour et potentiellement, pour l’économie dans son ensemble. Par contre, les terres agricoles ont un contenu carbone bien inférieur à une terre forestière et sont généralement pauvres en biodiversité. Les terres peuvent être utilisées de différentes manières afin de répondre à différents objectifs et il peut être potentiellement difficile de satisfaire tous ces objectifs à la fois, donnant lieu à des choix difficiles lors de la conception des politiques. Les pays membres de la Commission des forêts d'Afrique centrale (COMIFAC) ont identifié l’initiative pour la réduction des émissions issues de la déforestation et de la dégradation forestière et l'amélioration des stocks de carbone (REDD+) comme un enjeu majeur dans la dernière revision du Plan de Convergence pour la Gestion Durable des Forêts, aux côtés de la conservation et de l’utilisation durable de la diversité biologique et de la réduction des impacts du changement climatique. Cette étude a pour objectif d’identifier les zones soumises aux pressions de conversion les plus fortes dans le futur et les conséquences en termes de production agricole, d’émissions de gaz à effet de serre (GES) et de risque de perte de biodiversité, avec pour but d’accompagner les institutions impliquées dans la REDD+ ainsi que dans la planification des Stratégies Nationales et Plans d’Action pour la Biodiversité dans les pays de la COMIFAC