The health and social consequences of an alcohol related admission to critical care: a qualitative study

Objective: To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. Design: In-depth, semistructured interviews with participants ( patients) 3–7 months post intensive care discharge. Setting: The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients were allocated to one of the three alcohol groups: low risk, harmful/hazardous and alcohol dependency. Participants: 21 participants who received mechanical ventilation for greater than 3 days were interviewed between March 2013 and June 2014. Interventions: None. Measurements and main results: Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience, support for activities of daily living, social support and cohesion and the impact of alcohol use disorders on recovery. Participants also discussed the importance of personalised goal setting and appropriate and timely rehabilitation for alcohol-related behaviours during the critical care recovery period. Conclusions: There is a significant interplay between alcohol misuse and recovery from critical illness. This study has demonstrated that at present, there is a haphazard approach to rehabilitation for patients after ICU. A more targeted rehabilitation pathway for patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, requires to be generated

On the relativistic iron line and soft excess in the Seyfert 1 galaxy Markarian 335

We report on a 133 ks XMM-Newton observation of the Seyfert 1 galaxy Markarian 335. The 0.4-12 keV spectrum contains an underlying power law continuum, a soft excess below 2 keV, and a double-peaked iron emission feature in the 6-7 keV range. We investigate the possibility that the double-peaked emission might represent the characteristic signature of the accretion disc. Detailed investigations show that a moderately broad, accretion disc line is most likely present, but that the peaks may be owing to narrower components from more distant material. The peaks at 6.4 and 7 keV can be identified, respectively, with the molecular torus in active galactic nucleus unification schemes, and very highly ionized, optically thin gas filling the torus. The X-ray variability spectra on both long (~100 ks) and short (~1 ks) timescales disfavour the recent suggestion that the soft excess is an artifact of variable, moderately ionized absorption.Comment: 6 pages, 2 figures, accepted for publication in MNRA

CA-PCA: Manifold Dimension Estimation, Adapted for Curvature

The success of algorithms in the analysis of high-dimensional data is often attributed to the manifold hypothesis, which supposes that this data lie on or near a manifold of much lower dimension. It is often useful to determine or estimate the dimension of this manifold before performing dimension reduction, for instance. Existing methods for dimension estimation are calibrated using a flat unit ball. In this paper, we develop CA-PCA, a version of local PCA based instead on a calibration of a quadratic embedding, acknowledging the curvature of the underlying manifold. Numerous careful experiments show that this adaptation improves the estimator in a wide range of settings.Comment: 26 page

The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

Purpose: This study aimed to establish which prognostic scoring tool provides the greatest discriminative ability when assessing critically ill cirrhotic patients in a general intensive care unit (ICU) setting.<p></p> Methods: This was a 12-month, single-centered prospective cohort study performed in a general, nontransplant ICU. Forty clinical and demographic variables were collected on admission to calculate 8 prospective scoring tools. Patients were followed up to obtain ICU and inhospital mortality. Receiver operating characteristic curve analysis was used to determine the discriminative ability of the scores. Univariate and multivariate analyses were used to identify any independent predictors of mortality in these patients. The incorporation of any significant variables into the scoring tools was assessed.<p></p> Results: Fifty-nine cirrhotic patients were admitted over the study period, with an ICU mortality of 31%. All scores other than the renal-specific Acute Kidney Injury Network score had similar discriminative abilities, producing area under the curves of between 0.70 and 0.76. None reached the clinically applicable level of 0.8. The Sequential Organ Failure Assessment score was the best performing score. Lactate and ascites were individual predictors of ICU mortality with statistically significant odds ratios of 1.69 and 5.91, respectively. When lactate was incorporated into the Child-Pugh score, its prognostic accuracy increased to a clinically applicable level (area under the curve, 0.86).<p></p> Conclusions: This investigation suggests that established prognostic scoring systems should be used with caution when applied to the general, nontransplant ICU as compared to specialist centers. Our data suggest that serum arterial lactate may improve the prognostic ability of these scores

Transboundary Regional Planning Collaboration for Climate Change Adaptation: A Case Study of Jasper National Park, Mount Robson Provincial Park, and Willmore Wilderness Park.

Climate change threatens the integrity of many parks and protected areas worldwide. Mountain parks are amongst the most vulnerable, facing changes in temperature, hydrology, glaciation, fire frequency, and pest and disease outbreaks. Species migration is a key tool in climate change adaptation, but often physical and jurisdictional fragmentation makes it impossible for species to migrate, putting species at risk of extirpation or extinction. Transboundary collaboration and regional planning are tools that can help physically connected parks and protected areas overcome jurisdictional fragmentation and allow for species migration, giving species a greater chance at being able to adapt to climate change. However, there are many barriers to transboundary collaboration and regional planning that makes this difficult to achieve. This research aims to address the challenges parks face with regards to transboundary collaboration and regional planning, and provide possible solutions for overcoming these challenges. A qualitative research project was conducted to determine the state of transboundary collaboration and regional planning in the Canadian Rocky Mountains, using Jasper National Park, Mount Robson Provincial Park, and Willmore Wilderness Park as the study area. A document review, questionnaire, and Importance-Performance Analysis were conducted to determine: the current policy within the Parks Canada Agency, British Columbia Parks, and Alberta Parks in regards to the management implications of climate change; the degree to which transboundary collaboration and regional planning are occurring in and around the study area with regard to climate change; the challenges parks face with regards to transboundary collaboration and regional planning; how these challenges should be addressed; and to determine what park agencies and managers need to be able to participate in transboundary collaboration and regional planning. Ultimately, it became clear that while transboundary collaboration is a potentially effective tool for climate change adaptation, little transboundary collaboration is occurring within the study area. In order for this to occur, all parks must have appropriate legislation, policies, and plans in place; British Columbia Parks has these, but both Parks Canada and Alberta Parks do not. Parks planners and managers are not able to put priority on transboundary collaboration until it is mandated within the management plans. However, parks managers are supportive of transboundary collaboration for climate change and it seems likely that the parks will use this tool as it becomes increasingly necessary over the next 25 years

A play of voices in marine conservation: Human experiences of fishery closures in Zanzibar

Based on stories written by Elizabeth (Liz) Drury O’Neill. These stories were directly taken from the research transcripts of OctoPINTS’ fieldwork in 2019. The stories were edited into a play by Tim Daw and Emilie Lindkvist. Kiswahili translation was made by Irene Musa and Andrew Wamukota. Layout and editing by Jineth Berrío-Marínez. Front page illustration by Krisztina Jónás. In English AND Kiswahili. This play script is an outcome of the OctoPINTS project https://octopints.wordpress.com/, a research project funded jointly by VR the Swedish Research Council, Sida the Swedish International Development Cooperation Agency, Formas the Swedish Research Council for Sustainable Development and Forte (Dnr 2018-05862). With additional support from the Stockholm Resilience Centre, the University of Dar es Salaam, and Pwani University. With huge thanks to Mwambao coastal community network, fieldwork hosts and collaborators

“Bringing you the Best”: John Player & Sons, Cricket, and the Politics of Tobacco Sport Sponsorship in Britain, 1969–1986

This article explores some of the marketing strategies associated with the British tobacco industry's sponsorship of sport during the 1960s and 1970s. It focuses on the British cigarette and tobacco manufacturer John Player & Sons and the firm's pioneering initiative to sponsor one-day cricket, which began with the John Player League in 1969. The league was enormously popular and gained significant broadcast coverage, becoming an invaluable means of increasing public exposure for the company, in the context of the ban of cigarette advertising from British television. At a time when the link between smoking and disease was making headlines, John Player & Sons nimbly deflected attention away from the health issue, and instead consciously repositioned the tobacco company as a generous benefactor of the nation's sport and leisure. Less conspicuously, but even more powerfully, spokespeople for the tobacco industry actively mobilised influential opinion behind the scenes in political circles. We show particularly how Denis Howell, Minister for Sport from 1964 to 1969 and from 1974 to 1979, became a valuable ally, acting as a bulwark against more restrictive government interventions into the sponsorship of sports by the tobacco industry. This alliance exposes changing industry-government relations and presents new historical context to better understand the way British tobacco manufacturers proactively sought to elide restrictions on their advertising activities from the 1980s onward

AKT regulates NPM dependent ARF localization and p53mut stability in tumors

Nucleophosmin (NPM) is known to regulate ARF subcellular localization and MDM2 activity in response to oncogenic stress, though the precise mechanism has remained elusive. Here we describe how NPM and ARF associate in the nucleoplasm to form a MDM2 inhibitory complex. We find that oligomerization of NPM drives nucleolar accumulation of ARF. Moreover, the formation of NPM and ARF oligomers antagonizes MDM2 association with the inhibitory complex, leading to activation of MDM2 E3-ligase activity and targeting of p53. We find that AKT phosphorylation of NPM-Ser48 prevents oligomerization that results in nucleoplasmic localization of ARF, constitutive MDM2 inhibition and stabilization of p53. We also show that ARF promotes p53 mutant stability in tumors and suppresses p73 mediated p21 expression and senescence. We demonstrate that AKT and PI3K inhibitors may be effective in treatment of therapeutically resistant tumors with elevated AKT and carrying gain of function mutations in p53. Our results show that the clinical candidate AKT inhibitor MK-2206 promotes ARF nucleolar localization, reduced p53(mut) stability and increased sensitivity to ionizing radiation in a xenograft model of pancreatic cancer. Analysis of human tumors indicates that phospho-S48-NPM may be a useful biomarker for monitoring AKT activity and in vivo efficacy of AKT inhibitor treatment. Critically, we propose that combination therapy involving PI3K-AKT inhibitors would benefit from a patient stratification rationale based on ARF and p53(mut) status

The ABCDs of Pain Management: A Double-Blind Randomized Controlled Trial Examining the Impact of a Brief Educational Video on Infants’ and Toddlers’ Pain Scores and Parent Soothing Behavior

Objectives To test the efficacy of a brief behavioral pain management strategy (The ABCDs of Needle Pain Management), delivered via video, on infants’ and toddlers’ pain scores and on parental soothing behavior. Methods This was a double-blind, parallel trial design. Parent–child dyads (N = 128) were recruited before their child’s 6-month (infant) or 18-month (toddler) vaccination in a pediatric clinic and randomly assigned to watch a 5-min treatment video or a placebo video. The primary outcome was the Modified Behavior Pain Scale (Taddio et al., Journal of Pain and Symptom Management, 10, pp. 456–463, 1995), coded during four epochs (Pain Reactivity, Pain Regulation 1 min, Pain Regulation 2 min, and Pain Regulation 3 min) after the last vaccination needle. Secondary analyses examined parental use of distraction, rocking, and physical comforting over this same time period. Results Results demonstrated a treatment effect for toddlers (18-month-olds) for the Pain Regulation 1 (d = 0.84) and Pain Regulation 2 (d = 0.76) postvaccination scores. Secondary analyses found differences in parental rocking and physical comforting between treatment conditions and between age-groups (d’s = 0.37–0.54). Conclusions The ABCD pain management strategy delivered via video was an effective way to reduce toddler pain after vaccination and increase parental use of rocking and physical comforting. The treatment effect was not demonstrated with infants