Prophylactic Intra-Aortic Balloon Counterpulsation in High Risk Cardiac Surgery: The PINBALL Pilot Multicentre, Registry-Linked, Randomised, Controlled Feasibility Trial

Background: Prophylactic intra-aortic balloon counterpulsation (IABC) is commonly used in selected patients undergoing coronary artery bypass graft (CABG) surgery, but definitive evidence is lacking. The aim of the multicentre PINBALL Pilot randomised controlled trial (RCT) was to assess the feasibility of performing a definitive trial to address this question. Methods: Patients listed for CABG surgery with impaired left ventricular function and at least one additional risk factor for postoperative low cardiac output syndrome were eligible for inclusion if the treating surgical team was uncertain as to the benefit of prophylactic IABC. The primary outcome of feasibility was based on exceeding a pre-specified recruitment rate, protocol compliance and follow-up. Results: The recruitment rate of 0.5 participants per site per month did not meet the feasibility threshold of two participants per site per month and the study was stopped early after enrolment of 24 out of the planned sample size of 40 participants. For 20/24 (83%) participants, preoperative IABC use occurred according to study assignment. Six (6)-month follow-up was available for all enrolled participants, [IABC 1 death (8%) vs. control 1 death (9%), p = 0.95]. Conclusion: The PINBALL Pilot recruitment rate was insufficient to demonstrate feasibility of a multicentre RCT of prophylactic IABC in high risk patients undergoing CABG surgery

Synchronous oceanic spreading and continental rifting in West Antarctica

Magnetic anomalies associated with new ocean crust formation in the Adare Basin off north-western Ross Sea (43 – 26 Ma) can be traced directly into the Northern Basin that underlies the adjacent morphological continental shelf, implying a continuity in the emplacement of oceanic crust. Steep gravity gradients along the margins of the Northern Basin, particularly in the east, suggest that little extension and thinning of continental crust occurred before it ruptured and the new oceanic crust formed, unlike most other continental rifts and the Victoria Land Basin further south. A pre-existing weak crust and localisation of strain by strike slip faulting are proposed as the factors allowing the rapid rupture of continental crust

K-shell photoionization of ground-state Li-like carbon ions [C3+^{3+}]: experiment, theory and comparison with time-reversed photorecombination

Absolute cross sections for the K-shell photoionization of ground-state Li-like carbon [C$^{3+}$(1s$^2$2s $^2$S)] ions were measured by employing the ion-photon merged-beams technique at the Advanced Light Source. The energy ranges 299.8--300.15 eV, 303.29--303.58 eV and 335.61--337.57 eV of the [1s(2s2p)$^3$P]$^2$P, [1s(2s2p)$^1$P]$^2$P and [(1s2s)$^3$S 3p]$^2$P resonances, respectively, were investigated using resolving powers of up to 6000. The autoionization linewidth of the [1s(2s2p)$^1$P]$^2$P resonance was measured to be $27 \pm 5$ meV and compares favourably with a theoretical result of 26 meV obtained from the intermediate coupling R-Matrix method. The present photoionization cross section results are compared with the outcome from photorecombination measurements by employing the principle of detailed balance.Comment: 3 figures and 2 table

Linking Auxin with Photosynthetic Rate via Leaf Venation

International audienceLand plants lose vast quantities of water to the atmosphere during photosynthetic gas exchange. In angiosperms, a complex network of veins irrigates the leaf, and it is widely held that the density and placement of these veins determines maximum leaf hydraulic capacity and thus maximum photosynthetic rate. This theory is largely based on interspecific comparisons and has never been tested using vein mutants to examine the specific impact of leaf vein morphology on plant water relations. Here we characterize mutants at the Crispoid (Crd) locus in pea (Pisum sativum), which have altered auxin homeostasis and activity in developing leaves, as well as reduced leaf vein density and aberrant placement of free-ending veinlets. This altered vein phenotype in crd mutant plants results in a significant reduction in leaf hydraulic conductance and leaf gas exchange. We find Crispoid to be a member of the YUCCA family of auxin biosynthetic genes. Our results link auxin biosynthesis with maximum photosynthetic rate through leaf venation and substantiate the theory that an increase in the density of leaf veins coupled with their efficient placement can drive increases in leaf photosynthetic capacity

The General Practice Assessment Questionnaire (GPAQ) – Development and psychometric characteristics

<p>Abstract</p> <p>Background</p> <p>Continual quality improvement in primary care is an international priority. In the United Kingdom, the major initiative for improving quality of care is the Quality and Outcomes Framework (QoF) of the 2004 GP contract. Although the primary focus of the QoF is on clinical care, it is acknowledged that a comprehensive assessment of quality also requires valid and reliable measurement of the patient perspective, so financial incentives are included in the contract for general practices to survey patients' views. One questionnaire specified for use in the QoF is the General Practice Assessment Questionnaire (GPAQ). This paper describes the development of the GPAQ (with post-consultation and postal versions) and presents a preliminary examination of the psychometric properties of the questionnaire.</p> <p>Methods</p> <p>Description of scale development and preliminary analysis of psychometric characteristics (internal reliability, factor structure), based on a large dataset of routinely collected GPAQ surveys (n = 190,038 responses to the consultation version of GPAQ and 20,309 responses to the postal version) from practices in the United Kingdom during the 2005–6 contract year.</p> <p>Results</p> <p>Respondents tend to report generally favourable ratings. Responses were particularly skewed on the GP communication scale, though no more so than for other questionnaires in current use in the UK for which data were available. Factor analysis identified 2 factors that clearly relate to core concepts in primary care quality ('access' and 'interpersonal care') that were common to both version of the GPAQ. The other factors related to 'enablement' in the post-consultation version and 'nursing care' in the postal version.</p> <p>Conclusion</p> <p>This preliminary evaluation indicates that the scales of the GPAQ are internally reliable and that the items demonstrate an interpretable factor structure. Issues concerning the distributions of GPAQ responses are discussed. Potential further developments of the item content for the GPAQ are also outlined.</p

Emerging issues and current trends in assistive technology use 2007-1010: practising, assisting and enabling learning for all

Following an earlier review in 2007, a further review of the academic literature relating to the uses of assistive technology (AT) by children and young people was completed, covering the period 2007-2011. As in the earlier review, a tripartite taxonomy: technology uses to train or practise, technology uses to assist learning and technology uses to enable learning, was used in order to structure the findings. The key markers for research in this field and during these three years were user involvement, AT on mobile mainstream devices, the visibility of AT, technology for interaction and collaboration, new and developing interfaces and inclusive design principles. The paper concludes by locating these developments within the broader framework of the Digital Divide

A Comparative Exploration of Community Pharmacists' Views on the Nature and Management of Over-the-Counter (OTC) and Prescription Codeine Misuse in Three Regulatory Regimes: Ireland, South Africa and the United Kingdom

Misuse of codeine containing preparations is a public health concern given the potential for associated harms and dependence. This study explores the perspectives of community pharmacists in three regulatory regimes on issues of customer misuse of over-the-counter (OTC) and prescribed codeine. A qualitative design comprising six focus groups (n = 45) was conducted in Ireland, United Kingdom, South Africa. Transcripts were analysed using the constant comparative method of content analysis. Pharmacists described popular codeine-containing products and the need for improved medicine information and warning labels. Issues around legitimate availability of codeine and regulatory status; presence of therapeutic need; difficulties in customer–pharmacist communication; business environments and retail focus were raised. Participants also discussed how they identified customers potentially misusing codeine and difficulties in relationships between pharmacists and prescribers. A number of recommendations were put forward as ways to manage the issues. The study highlights the difficulties encountered by community pharmacists operating under various regulatory regimes when supplying codeine containing preparations in negotiating patient awareness and compliance and potential ways to deal with misuse and dependence