Reduced leakage current in Josephson tunnel junctions with codeposited barriers

Josephson junctions were fabricated using two different methods of barrier formation. The trilayers employed were Nb/Al-AlOx/Nb on sapphire, where the first two layers were epitaxial. The oxide barrier was formed either by exposing the Al surface to O2 or by codepositing Al in an O2 background. The codeposition process yielded junctions that showed the theoretically predicted subgap current and no measurable shunt conductance. In contrast, devices with barriers formed by thermal oxidation showed a small shunt conductance in addition to the predicted subgap current.Comment: 3 pages, 4 figure

Developing a framework for carbohydrate awareness advice in type two diabetes

Type 2 Diabetes (T2DM) is a long-term condition in which dietary management is central, however there remains uncertainty about the most effective way to advise patients with T2DM about carbohydrate, even amongst Registered Dietitians (RDs). This research aimed to develop a framework for carbohydrate awareness advice using mixed methods research. Firstly, a meta-analysis found that evidence is lacking for a widespread carbohydrate restriction but restricting to below 130g per day offers short-term benefits for improving glycaemic control. The qualitative study involving interviews with people with T2DM and focus groups with RDs highlighted the importance of individualising advice for patients and identified helpful and unhelpful aspects of RD advice. RD reported practice varies, however they were able to describe carbohydrate awareness advice and outline key areas for professional development. Kleinman’s Explanatory Model and related concepts were applied to the findings from the two qualitative parts of the research and the systematic review. This allowed the construction of the Carbohydrate Awareness Advice Framework (CAAF) using the findings from this research and based on a strong theoretical foundation. The CAAF incorporates the findings from both the quantitative and qualitative research conducted for this thesis and should form the basis for an intervention in future clinical trials

Tumour inflammatory infiltrate predicts survival following curative resection for node-negative colorectal cancer

<b>Background</b>: A pronounced tumour inflammatory infiltrate is known to confer a good outcome in colorectal cancer. Klintrup and colleagues reported a structured assessment of the inflammatory reaction at the invasive margin scoring low grade or high grade. The aim of the present study was to examine the prognostic value of tumour inflammatory infiltrate in node-negative colorectal cancer. <b>Methods</b>: Two hundred patients had undergone surgery for node-negative colorectal cancer between 1997 and 2004. Specimens were scored with Jass’ and Klintrup’s criteria for peritumoural infiltrate. Pathological data were taken from the reports at that time. <b>Results</b>: Low-grade inflammatory infiltrate assessed using Klintrup’s criteria was an independent prognostic factor in node-negative disease. In patients with a low-risk Petersen Index (n = 179), low-grade infiltrate carried a threefold increased risk of cancer death. Low-grade infiltrate was related to increasing T stage and an infiltrating margin. <b>Conclusion</b>: Assessment of inflammatory infiltrate using Klintrup’s criteria provides independent prognostic information on node-negative colorectal cancer. A high-grade local inflammatory response may represent effective host immune responses impeding tumour growth

Bridging the second gap in translation:A case study of barriers and facilitators to implementing Patient-initiated Clinics into secondary care

Abstract Rationale: Patient-initiated clinics (PIC) have been found to be safe and have patient and service benefits in terms of satisfaction and cost. This paper reports our experiences of implementing PIC and the practical challenges of translating research into practice. Methods: The Knowledge to Action framework was used to inform the design of implementation plans in three different departments in one secondary health care organisation. A focused ethnographic approach was utilised to collect data on barriers and facilitators to implementation which were analysed using iterative qualitative analytic techniques. The Promoting Action on Research Implementation in Health Services framework was used to develop the analysis and data presentation. Results: The success of implementation was mixed across the three departments. Despite evidence of effectiveness, contextual issues at a department level, such as empowered leadership and team members, trust in colleagues and patients and capacity to make changes, impacted on the progress of implementation. Discussion: Patient Initiated Clinics can offer a useful and feasible alternative for follow-up care of some groups of patients with long-term conditions in secondary care, and can be implemented through strong leadership and teamwork and a positive attitude to change. Although Implementation Science as an emerging field offers useful tools and theoretical support, its complexity may create additional challenges to implementation of specific interventions, and so further contribute to the second gap in translation.This research was funded by the South West Academic Health Science Network (AHSN) and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The AHSN and the NIHR had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication

ENVIROSAT-2000 report: Federal agency satellite requirements

The requirement of Federal agencies, other than NOAA, for the data and services of civil operational environmental satellites (both polar orbiting and geostationary) are summarized. Agency plans for taking advantage of proposed future Earth sensing space systems, domestic and foreign, are cited also. Current data uses and future requirements are addressed as identified by each agency

Distinct Kinin-Induced Functions Are Altered in Circulating Cells of Young Type 1 Diabetic Patients

We aimed to understand early alterations in kinin-mediated migration of circulating angio-supportive cells and dysfunction of kinin-sensitive cells in type-1 diabetic (T1D) patients before the onset of cardiovascular disease.Total mononuclear cells (MNC) were isolated from peripheral blood of 28 T1D patients free from cardiovascular complications except mild background retinopathy (age: 34.8+/-1.6 years, HbA(1C): 7.9+/-0.2%) and 28 age- and sex-matched non-diabetic controls (H). We tested expression of kinin receptors by flow cytometry and migratory capacity of circulating monocytes and progenitor cells towards bradykinin (BK) in transwell migration assays. MNC migrating towards BK (BK(mig)) were assessed for capacity to support endothelial cell function in a matrigel assay, as well as generation of nitric oxide (NO) and superoxide (O(2) (-)*) by using the fluorescent probes diaminofluorescein and dihydroethidium.CD14(hi)CD16(neg), CD14(hi)CD16(pos) and CD14(lo)CD16(pos) monocytes and circulating CD34(pos) progenitor cells did not differ between T1D and H subjects in their kinin receptor expression and migration towards BK. T1D BK(mig) failed to generate NO upon BK stimulation and supported endothelial cell network formation less efficiently than H BK(mig). In contrast, O(2) (-)* production was similar between groups. High glucose disturbed BK-induced NO generation by MNC-derived cultured angiogenic cells.Our data point out alterations in kinin-mediated functions of circulating MNC from T1D patients, occurring before manifest macrovascular damage or progressed microvascular disease. Functional defects of MNC recruited to the vessel wall might compromise endothelial maintenance, initially without actively promoting endothelial damage, but rather by lacking supportive contribution to endothelial regeneration and healing

Relationship between emergency presentation, systemic inflammatory response, and cancer-specific survival in patients undergoing potentially curative surgery for colon cancer

Background Emergency presentation is recognized to be associated with poorer cancer-specific survival following curative resection for colorectal cancer. The present study examined the hypothesis that an enhanced systemic inflammatory response, prior to surgery, might explain the impact of emergency presentation on survival. Methods In all, 188 patients undergoing potentially curative resection for colorectal cancer were studied. Of these, 55 (29%) presented as emergencies. The systemic inflammatory response was assessed using the Glasgow Prognostic Score (mGPS), which is the combination of an elevated C-reactive protein (>10 mg/L) and hypoalbuminemia (<35 g/L). Results In the emergency group, tumor stage was greater (P < 0.01), more patients received adjuvant therapy (P < 0.01) more patients had an elevated mGPS (P < 0.01), and more patients died of their disease (P < 0.05). The minimum follow-up was 12 months; the median follow-up of the survivors was 48 months. Emergency presentation was associated with poorer 3-year cancer-specific survival in those patients aged 65 to 74 years (P < 0.01), in both males and females (P < 0.05), in the deprived (P < 0.01), in patients with tumor-node-metastasis (TNM) stage II disease (P < 0.01), in those who received no adjuvant therapy (P < 0.01), and in the mGPS 0 and 1 groups (P < 0.05) groups. On multivariate survival analysis of patients undergoing potentially curative surgery for TNM stage II colon cancer, emergency presentation (P < 0.05) and mGPS (P < 0.05) were independently associated with cancer-specific survival. Conclusions These results suggest that emergency presentation and the presence of systemic inflammatory response prior to surgery are linked and account for poorer cancer-specific survival in patients undergoing potentially curative surgery for colon cancer. Both emergency presentation and an elevated mGPS should be taken into account when assessing the likely outcome of these patients

Carbohydrate restriction for glycemic control in Type 2 diabetes : a systematic review and meta-analysis

Aim To conduct a systematic review and meta‐analysis to evaluate the effect of carbohydrate restriction on glycaemic control in Type 2 diabetes. Methods We searched Medline, EMBASE and CINAHL for the period between 1976 and April 2018. We included randomized controlled trials comparing carbohydrate restriction with a control diet which aimed to maintain or increase carbohydrate intake, and that reported HbA1c as an outcome and reported the amount of carbohydrate consumed during or at the end of the study, with outcomes reported at ≥3 months. Results We identified 1402 randomized controlled trials, 25 of which met the inclusion criteria, incorporating 2132 participants for the main outcome. Definitions of low carbohydrate varied among the studies. The pooled effect estimate from meta‐analysis was a weighted mean difference of –0.09% [95% CI –0.27, 0.08 (P = 0.30); I2 72% (P <0.001)], suggesting no effect on HbA1c of restricting the quantity of carbohydrate. A subgroup analysis of diets containing 50–130 g carbohydrate resulted in a pooled effect estimate of –0.49% [95% CI –0.75, –0.23 (P <0.001); I2 0% (P = 0.56)], suggesting a clinically and statistically significant effect on HbA1c in favour of low‐carbohydrate diets in studies of ≤6 months’ duration. Conclusions There was no overall pooled effect on HbA1c in favour of restricting carbohydrate; however, restriction of carbohydrate to 50–130 g per day had beneficial effects on HbA1c in trials up to 6 months. Future randomized controlled trials should be of >12 months’ duration, assess pre‐study carbohydrate intake, use recognized definitions of low‐carbohydrate diets and examine reasons for non‐concordance in greater detail