Some Public Health Problems of War Evacuation in the County of Northampton

Abstract Not Provided

Association Between Residential Greenness and Cardiovascular Disease Risk

Background Exposure to green vegetation has been linked to positive health, but the pathophysiological processes affected by exposure to vegetation remain unclear. To study the relationship between greenness and cardiovascular disease, we examined the association between residential greenness and biomarkers of cardiovascular injury and disease risk in susceptible individuals. Methods and Results In this cross-sectional study of 408 individuals recruited from a preventive cardiology clinic, we measured biomarkers of cardiovascular injury and risk in participant blood and urine. We estimated greenness from satellite-derived normalized difference vegetation index ( NDVI ) in zones with radii of 250 m and 1 km surrounding the participants' residences. We used generalized estimating equations to examine associations between greenness and cardiovascular disease biomarkers. We adjusted for residential clustering, demographic, clinical, and environmental variables. In fully adjusted models, contemporaneous NDVI within 250 m of participant residence was inversely associated with urinary levels of epinephrine (-6.9%; 95% confidence interval, -11.5, -2.0/0.1 NDVI ) and F2-isoprostane (-9.0%; 95% confidence interval, -15.1, -2.5/0.1 NDVI ). We found stronger associations between NDVI and urinary epinephrine in women, those not on β-blockers, and those who had not previously experienced a myocardial infarction. Of the 15 subtypes of circulating angiogenic cells examined, 11 were inversely associated (8.0-15.6% decrease/0.1 NDVI ), whereas 2 were positively associated (37.6-45.8% increase/0.1 NDVI ) with contemporaneous NDVI . Conclusions Independent of age, sex, race, smoking status, neighborhood deprivation, statin use, and roadway exposure, residential greenness is associated with lower levels of sympathetic activation, reduced oxidative stress, and higher angiogenic capacity

Multicentre, double-blind, randomised, sham-controlled trial of 10 khz high-frequency spinal cord stimulation for chronic neuropathic low back pain (MODULATE-LBP): a trial protocol

Introduction: chronic neuropathic low back pain (CNLBP) is a debilitating condition in which established medical treatments seldom alleviate symptoms. Evidence demonstrates that high-frequency 10 kHz spinal cord stimulation (SCS) reduces pain and improves health-related quality of life in patients with failed back surgery syndrome (FBSS), but evidence of this effect is limited in individuals with CNLBP who have not had surgery. The aim of this multicentre randomised trial is to assess the clinical and cost-effectiveness of 10 kHz SCS for this population.Methods: this is a multicentre, double-blind, randomised, sham-controlled trial with a parallel economic evaluation. A total of 96 patients with CNLBP who have not had spinal surgery will be implanted with an epidural lead and a sham lead outside the epidural space without a screening trial. Patients will be randomised 1:1 to 10 kHz SCS plus usual care (intervention group) or to sham 10 kHz SCS plus usual care (control group) after receiving the full implant. The SCS devices will be programmed identically using a cathodal cascade. Participants will use their handheld programmer to alter the intensity of the stimulation as per routine practice. The primary outcome will be a 7-day daily pain diary. Secondary outcomes include the Oswestry Disability Index, complications, EQ-5D-5 L, and health and social care costs. Outcomes will be assessed at baseline (pre-randomisation) and at 1 month, 3 months and 6 months after device activation. The primary analyses will compare primary and secondary outcomes between groups at 6 months, while adjusting for baseline outcome scores. Incremental cost per quality-adjusted life year (QALY) will be calculated at 6 months and over the lifetime of the patient.Discussion: the outcomes of this trial will inform clinical practice and healthcare policy on the role of high-frequency 10 kHz SCS for use in patients with CNLBP who have not had surgery.Trial registration: Clinicaltrials.gov, NCT03470766. Registered on 20 March 2018.Disclaimer: the views expressed here are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The NIHR had no role in the study design, writing of the manuscript or the decision to submit for publication.Roles and Responsibilities: AK, SP, DP, SW, RST, AC, SE, LM, RD and JF all contributed to the trial design and to securing trial funding. AK, JR, SP, DP, and SE are involved in the recruitment, the intervention and the follow-up. SW will perform data collection and analysis. RST will be responsible for the statistical analysis, and RD will be responsible for the health economic analysis. All authors read and approved the final manuscript.<br/

Key traits for ruminant livestock across diverse production systems in the context of climate change: perspectives from a global platform of research farms

Ruminant livestock are raised under diverse cultural and environmental production systems around the globe. Ruminant livestock can play a critical role in food security by supplying high-quality, nutrient-dense food with little or no competition for arable land while simultaneously improving soil health through vital returns of organic matter. However, in the context of climate change and limited land resources, the role of ruminant-based systems is uncertain because of their reputed low efficiency of feed conversion (kilogram of feed required per kilogram of product) and the production of methane as a by-product of enteric fermentation. A growing human population will demand more animal protein, which will put greater pressure on the Earth’s planetary boundaries and contribute further to climate change. Therefore, livestock production globally faces the dual challenges of mitigating emissions and adapting to a changing climate. This requires research-led animal and plant breeding and feeding strategies to optimise ruminant systems. This study collated information from a global network of research farms reflecting a variety of ruminant production systems in diverse regions of the globe. Using this information, key changes in the genetic and nutritional approaches relevant to each system were drawn that, if implemented, would help shape more sustainable future ruminant livestock systems

The opto-mechanical design of the GMT-Consortium Large Earth Finder (G-CLEF)

The GMT-Consortium Large Earth Finder (G-CLEF) will be part of the first generation instrumentation suite for the Giant Magellan Telescope (GMT). G-CLEF is a general purpose echelle spectrograph operating in the optical passband with precision radial velocity (PRV) capability. The measurement precision goal of G-CLEF is 10 cm/sec; necessary for the detection of Earth analogues. This goal imposes challenging stability requirements on the optical mounts and spectrograph support structures especially when considering the instrument's operational environment. G-CLEF's accuracy will be influenced by changes in temperature and ambient air pressure, vibration, and micro gravity-vector variations caused by normal telescope motions. For these reasons we have chosen to enclose G-CLEF's spectrograph in a wellinsulated, vibration-isolated vacuum chamber in a gravity invariant location on GMT's azimuth platform. Additional design constraints posed by the GMT telescope include; a limited space envelope, a thermal leakage ceiling, and a maximum weight allowance. Other factors, such as manufacturability, serviceability, available technology, and budget are also significant design drivers. G-CLEF will complete its Critical Design phase in mid-2018. In this paper, we discuss the design of GCLEF's optical mounts and support structures including the choice of a low-CTE carbon-fiber optical bench. We discuss the vacuum chamber and vacuum systems. We discuss the design of G-CLEF's insulated enclosure and thermal control systems which simultaneously maintain the spectrograph at milli-Kelvin level stability and limit thermal leakage into the telescope dome. Also discussed are micro gravity-vector variations caused by normal telescope slewing, their uncorrected influence on image motion, and how they are dealt with in the design. We discuss G-CLEF's front-end assembly and fiber-feed system as well as other interface, integration and servicing challenges presented by the telescope, enclosure, and neighboring instrumentation. This work has been supported by the GMTO Corporation, a non-profit organization operated on behalf of an international consortium of universities and institutions: Arizona State University, Astronomy Australia Ltd, the Australian National University, the Carnegie Institution for Science, Harvard University, the Korea Astronomy and Space Science Institute, the São Paulo Research Foundation, the Smithsonian Institution, the University of Texas at Austin, Texas AM University, the University of Arizona, and the University of Chicago

An Extreme Precision Radial Velocity Pipeline: First Radial Velocities from EXPRES

The EXtreme PREcision Spectrograph (EXPRES) is an environmentally stabilized, fiber-fed, $R=137,500$, optical spectrograph. It was recently commissioned at the 4.3-m Lowell Discovery Telescope (LDT) near Flagstaff, Arizona. The spectrograph was designed with a target radial-velocity (RV) precision of 30$\mathrm{~cm~s^{-1}}$. In addition to instrumental innovations, the EXPRES pipeline, presented here, is the first for an on-sky, optical, fiber-fed spectrograph to employ many novel techniques---including an "extended flat" fiber used for wavelength-dependent quantum efficiency characterization of the CCD, a flat-relative optimal extraction algorithm, chromatic barycentric corrections, chromatic calibration offsets, and an ultra-precise laser frequency comb for wavelength calibration. We describe the reduction, calibration, and radial-velocity analysis pipeline used for EXPRES and present an example of our current sub-meter-per-second RV measurement precision, which reaches a formal, single-measurement error of 0.3$\mathrm{~m~s^{-1}}$ for an observation with a per-pixel signal-to-noise ratio of 250. These velocities yield an orbital solution on the known exoplanet host 51 Peg that matches literature values with a residual RMS of 0.895$\mathrm{~m~s^{-1}}$

IQuaD dental trial; improving the quality of dentistry : a multicentre randomised controlled trial comparing oral hygiene advice and periodontal instrumentation for the prevention and management of periodontal disease in dentate adults attending dental primary care

Peer reviewedPublisher PD

Epidemiology of injuries from fire, heat and hot substances : global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study

Background Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. Methods We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. Results Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). Conclusions The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.Peer reviewe