The physiological expression of inducible nitric oxide synthase (iNOS) in the human colon

Inducible nitric oxide synthase (iNOS) is expressed in the colonic epithelium in both inflammatory bowel disease and colorectal cancer. Nitric oxide (NO), the product of this enzyme, has been implicated in the pathogenesis of both conditions. However, there are conflicting data on whether iNOS is expressed in the normal, uninflamed human colon. To evaluate the expression of iNOS in histologically normal, non-inflamed human colonic mucosa. Reverse transcription polymerase chain reaction (RT-PCR), immunoblotting, and immunohistochemistry were used to investigate the expression of iNOS in 17 histologically normal specimens obtained at colectomy performed for colorectal neoplasia. In addition, 16 endoscopic mucosal biopsies, taken from normal individuals, were also evaluated. Eleven surgical specimens and 16 endoscopic biopsies from patients with refractory ulcerative colitis were used as inflammatory controls. All types of specimens expressed iNOS mRNA. Immunoblotting revealed a protein of approximately 130 kDa consistent with iNOS in mucosal extracts of 77% of normal individuals, and 85% of diseased controls. Immunolabelling localised this protein to the surface epithelium in most of the normal specimens and also to the crypt epithelium and inflammatory cells in the diseased controls. These findings provide evidence that iNOS is often expressed in the surface epithelium of non-inflamed human colon, suggesting that it is induced by local luminal factors, such as bacterial lipopolysaccharide (endotoxin). The resultant NO produced at this site might act as an oxidative barrier, reducing bacterial translocation and providing a means of defence against pathogenic microorganisms

Structural dynamic parameter identification and the effect of test techniques

PublishedAmbient and forced excitation test techniques are both widely used to dynamically identify civil engineering structures. Two floor levels of a newly constructed building, the Charles Institute at University College Dublin, were tested using both techniques. Both floor designs were identical although the layout of partitions above and below each were different. The objective of the tests was to determine the most appropriate test procedure and also to identify whether the layout of partitions contributes in a significant manner to dynamic response. It was found that at low levels of excitation, ambient test levels, the dynamic response of both floors was identical. In contrast, at higher vibration excitation levels, during forced vibration testing, the floor responses were substantially different. The differing modal parameters identified are attributed to an amplitude dependent response resulting from engagement, or not, of the partitions in the dynamic response of the system. The practical significance of this finding is that it is imperative to consider, and test at, the in-service vibration amplitude expected for a floor system. © The Society for Experimental Mechanics, Inc. 2013

Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: patient and provider perspectives

© 2017 John Wiley & Sons Ltd Aims & Objectives: The purpose of this study was to elucidate the barriers and enablers to adherence to anticoagulation in individuals with chronic heart failure (CHF) with concomitant atrial fibrillation (AF) from the perspective of patients and providers. Background: CHF and AF commonly coexist and are associated with increased stroke risk and mortality. Oral anticoagulation significantly reduces stroke risk and improves outcomes. Yet, in approximately 30% of cases, anticoagulation is not commenced for a variety of reasons. Design: Qualitative study using narrative inquiry. Methods: Data from face-to-face individual interviews with patients and information retrieved from healthcare file note review documented the clinician perspective. This study is a synthesis of the two data sources, obtained during patient clinical assessments as part of the Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failuRe (AFASTER) Study. Results: Patient choice and preference were important factors in anticoagulation decisions, including treatment burden, unfavourable or intolerable side effects and patient refusal. Financial barriers included cost of travel, medication cost and reimbursement. Psychological factors included psychiatric illness, cognitive impairment and depression. Social barriers included homelessness and the absence of a caregiver or lack of caregiver assistance. Clinician reticence included fear of falls, frailty, age, fear of bleeding and the challenges of multimorbidity. Facilitators to successful prescription and adherence were caregiver support, reminders and routine, self-testing and the use of technology. Conclusions: Many barriers remain to high-risk individuals being prescribed anticoagulation for stroke prevention. There are a number of enabling factors that facilitate prescription and optimise treatment adherence. Nurses should challenge these treatment barriers and seek enabling factors to optimise therapy. Relevance to clinical practice: Nurses can help patients and caregivers to understand complex anticoagulant risk-benefit information, and act as a patient advocate when making complex stroke prevention decisions

Atrial fibrillation and thromboprophylaxis in heart failure: The need for patient-centered approaches to address adherence

Atrial fibrillation is a common arrhythmia in heart failure and a risk factor for stroke. Risk assessment tools can assist clinicians with decision making in the allocation of thromboprophylaxis. This review provides an overview of current validated risk assessment tools for atrial fibrillation and emphasizes the importance of tailoring individual risk and the importance of weighing the benefits of treatment. Further, this review provides details of innovative and patient-centered methods for ensuring optimal adherence to prescribed therapy. Prior to initiating oral anticoagulant therapy, a comprehensive risk assessment should include evaluation of associated cardiogeriatric conditions, potential for adherence to prescribed therapy, frailty, and functional and cognitive ability. © 2013 Ferguson et al, publisher and licensee Dove Medical Press Ltd

Addressing the stroke evidence-treatment gap

Stroke is one of the world’s largest contributors to mortality, and a leading cause of longterm disability. Yet, this remains an area of healthcare that continues to receive little attention through the media. There is urgent need for vital stroke funding to improve gaps in evidence-based stroke care. We are faced with a public health crisis

Categories of SHM deployments: Technologies and capabilities

The findings of an extensive literature survey focusing on bridge structural health monitoring (SHM) deployments are presented. Conventional, maturing, and emerging technologies are reviewed as well as deployment considerations for new SHM endeavors. The lack of published calibration studies (and quantification of uncertainty studies) for new sensors is highlighted as a major concern and area for future research. There are currently very few examples of SHM systems that have clearly provided significant value to the owners of monitored structures. The results of the literature survey are used to propose a categorization system to better assess the potential outcomes of bridge SHM deployments. It is shown that SHM studies can be categorized as one (or a combination) of the following: (1) anomaly detection, (2) sensor deployment studies, (3) model validation, (4) threshold check, and (5) damage detection. The new framework aids engineers specifying monitoring systems to determine what should be measured and why, hence allowing them to better evaluate what value may be delivered to the relevant stakeholders for the monitoring investments.This work was partly funded by EPSRC Grant No. EP/K000314/1: Innovation Knowledge Centre for Smart Infrastructure and Construction.This is the final version of the article. It first appeared from American Society of Civil Engineers via http://dx.doi.org/10.1061/(ASCE)BE.1943-5592.000073

Analysis of fiber-optic strain-monitoring data from a prestressed concrete bridge

This paper presents data from fiber-optic strain monitoring of the Nine Wells Bridge, which is a three-span, pretensioned, prestressed concrete beam-and-slab bridge located in Cambridgeshire in the United Kingdom. The original deployment at the site and the challenges associated with collecting distributed strain data using the Brillouin optical time domain reflectometry (BOTDR) technique are described. In particular, construction and deployment issues of fiber robustness and temperature effects are highlighted. The challenges of interpreting the collected data as well as the potential value of information that may be obtained are discussed. Challenges involved with relating measurements to the expected levels of prestress, including the effects due to debonding, creep, and shrinkage, are discussed and analyzed. This paper provides an opportunity to study whether two commonly used models for creep and shrinkage, adequately model data collected in field conditions.This work was supported by the following EPSRC grants: EP/D076870/1, Smart Infrastructure: Wireless Sensor Network System for Condition Assessment and Monitoring of Infrastructure; EP/I019308/1, Innovation Knowledge Centre for Smart Infrastructure and Construction; and EP/K000314/1, Innovation and Knowledge Centre for Smart Infrastructure and Construction - Collaborative Programme Tranche 1

Understanding the threats posed by non-native species: public vs. conservation managers.

Public perception is a key factor influencing current conservation policy. Therefore, it is important to determine the influence of the public, end-users and scientists on the prioritisation of conservation issues and the direct implications for policy makers. Here, we assessed public attitudes and the perception of conservation managers to five non-native species in the UK, with these supplemented by those of an ecosystem user, freshwater anglers. We found that threat perception was not influenced by the volume of scientific research or by the actual threats posed by the specific non-native species. Media interest also reflected public perception and vice versa. Anglers were most concerned with perceived threats to their recreational activities but their concerns did not correspond to the greatest demonstrated ecological threat. The perception of conservation managers was an amalgamation of public and angler opinions but was mismatched to quantified ecological risks of the species. As this suggests that invasive species management in the UK is vulnerable to a knowledge gap, researchers must consider the intrinsic characteristics of their study species to determine whether raising public perception will be effective. The case study of the topmouth gudgeon Pseudorasbora parva reveals that media pressure and political debate has greater capacity to ignite policy changes and impact studies on non-native species than scientific evidence alone

Head Position in Stroke Trial (HeadPoST)- sitting-up vs lying-flat positioning of patients with acute stroke: study protocol for a cluster randomised controlled trial

Background Positioning a patient lying-flat in the acute phase of ischaemic stroke may improve recovery and reduce disability, but such a possibility has not been formally tested in a randomised trial. We therefore initiated the Head Position in Stroke Trial (HeadPoST) to determine the effects of lying-flat (0°) compared with sitting-up (≥30°) head positioning in the first 24 hours of hospital admission for patients with acute stroke. Methods/Design We plan to conduct an international, cluster randomised, crossover, open, blinded outcome-assessed clinical trial involving 140 study hospitals (clusters) with established acute stroke care programs. Each hospital will be randomly assigned to sequential policies of lying-flat (0°) or sitting-up (≥30°) head position as a ‘business as usual’ stroke care policy during the first 24 hours of admittance. Each hospital is required to recruit 60 consecutive patients with acute ischaemic stroke (AIS), and all patients with acute intracerebral haemorrhage (ICH) (an estimated average of 10), in the first randomised head position policy before crossing over to the second head position policy with a similar recruitment target. After collection of in-hospital clinical and management data and 7-day outcomes, central trained blinded assessors will conduct a telephone disability assessment with the modified Rankin Scale at 90 days. The primary outcome for analysis is a shift (defined as improvement) in death or disability on this scale. For a cluster size of 60 patients with AIS per intervention and with various assumptions including an intracluster correlation coefficient of 0.03, a sample size of 16,800 patients at 140 centres will provide 90 % power (α 0.05) to detect at least a 16 % relative improvement (shift) in an ordinal logistic regression analysis of the primary outcome. The treatment effect will also be assessed in all patients with ICH who are recruited during each treatment study period. Discussion HeadPoST is a large international clinical trial in which we will rigorously evaluate the effects of different head positioning in patients with acute stroke. Trial registration ClinicalTrials.gov identifier: NCT02162017 (date of registration: 27 April 2014); ANZCTR identifier: ACTRN12614000483651 (date of registration: 9 May 2014). Protocol version and date: version 2.2, 19 June 2014