A postal survey to identify and describe nurse led clinics in genitourinary medicine services across England

Background: Nurses in genitourinary medicine (GUM) services are progressively extending their roles to conduct "comprehensive care" nurse led clinics. In such roles the nurse coordinates the first line, comprehensive care of patients presenting with sexual health conditions and issues. Objectives: To identify and describe comprehensive care nurse led clinics in GUM services across England. Methods: A postal questionnaire consisting of 17 closed response questions was sent to 209 GUM services across England. A second questionnaire was sent to non-responders to increase the response rate. Data were single entered and analysed using SPSS. Results: Of the 190 GUM clinic respondents (91% response rate), 44 (23%) reported providing some form of comprehensive care nurse led clinic, 90% of which were initiated since 1995. Key results show staff development featured as the main reason for initiating such services and there was general consistency in the aspects of care undertaken by these nurses. There was evidence of guideline development specific to nurse led care and some patient group direction use for supplying medication. The level of support from medical staff while nurse led clinics were being conducted varied between services. Few services have conducted any audit or research to monitor/evaluate nurse led care. There was little consistency in the clinical experience and educational prerequisites to undertake comprehensive care nurse led clinics. Continuing professional development opportunities also varied between services. Conclusions: The steady growth of comprehensive care nurse led clinics indicates that the skills of GUM nurses are being recognised. Nurses working in advanced practice roles now require courses and study days reflecting these changes in practice. Locally agreed practice guidelines can define nursing practice boundaries and ensure accountability, as will the development of patient group directions to supply medication. Monitoring and evaluation of nurse led clinics also require attention

Local properties of patterned vegetation: quantifying endogenous and exogenous effects

Dryland ecosystems commonly exhibit periodic bands of vegetation, thought to form due to competition between individual plants for heterogeneously distributed water. In this paper, we develop a Fourier method for locally identifying the pattern wavenumber and orientation, and apply it to aerial images from a region of vegetation patterning near Fort Stockton, Texas. We find that the local pattern wavelength and orientation are typically coherent, but exhibit both rapid and gradual variation driven by changes in hillslope gradient and orientation, the potential for water accumulation, or soil type. Endogenous pattern dynamics, when simulated for spatially homogeneous topographic and vegetation conditions, predict pattern properties that are much less variable than the orientation and wavelength observed in natural systems. Our local pattern analysis, combined with ancillary datasets describing soil and topographic variation, highlights a largely unexplored correlation between soil depth, pattern coherence, vegetation cover and pattern wavelength. It also, surprisingly, suggests that downslope accumulation of water may play a role in changing vegetation pattern properties

Caustic Structures and Detectability of Circumbinary Planets in Microlensing

Recent discoveries of circumbinary planets in Kepler data show that there is a viable channel of planet formation around binary main sequence stars. Motivated by these discoveries, we have investigated the caustic structures and detectability of circumbinary planets in microlensing events. We have produced a suite of animations of caustics as a function of the projected separation and angle of the binary host to efficiently explore caustic structures over the entire circumbinary parameter space. Aided by these animations, we have derived a semi-empirical analytic expression for the location of planetary caustics, which are displaced in circumbinary lenses relative to those of planets with a single host. We have used this expression to show that the dominant source of caustic motion will be due to the planet's orbital motion and not that of the binary star. Finally, we estimate the fraction of circumbinary microlensing events that are recognizable as such to be significant (5-50 percent) for binary projected separations in the range 0.1-0.5 in units of Einstein radii.Comment: 15 pages, 1 table, 18 figures. Accepted for publication in Ap

How typical is the Coma cluster?

Coma is frequently used as the archetype z~0 galaxy cluster to compare higher redshift work against. It is not clear, however, how representative the Coma cluster is for galaxy clusters of its mass or X-ray luminosity, and significantly: recent works have suggested that the galaxy population of Coma may be in some ways anomolous. In this work, we present a comparison of Coma to an X-ray selected control sample of clusters. We show that although Coma is typical against the control sample in terms of its internal kinematics (substructure and velocity dispersion profile), it has a significantly high (~3sigma) X-ray temperature set against clusters of comparable mass. By de-redshifting our control sample cluster galaxies star-formation rates using a fit to the galaxy main sequence evolution at z < 0.1, we determine that the typical star-formation rate of Coma galaxies as a function of mass is higher than for galaxies in our control sample at a confidence level of > 99 per cent. One way to alleviate this discrepency and bring Coma in-line with the control sample would be to have the distance to Coma to be slightly lower, perhaps through a non-negligible peculiar velocity with respect to the Hubble expansion, but we do not regard this as likely given precision measurements using a variety of approaches. Therefore in summary, we urge caution in using Coma as a z~0 baseline cluster in galaxy evolution studies.Comment: accepted for publication in MNRA

Gender and parenting stress using Abidin\u27s Parenting Stress Index

The effect of gender on parenting stress was studied on a sample of 56 parents at the time of custody disputes. Each pair of parents completed the Parenting Stress Index or the Parenting Stress Index/Short Form. Results were not significant when gender was matched to the total parent stress scores, indicating parent child stress was not associated with parent gender as was found in previous research

Feasibility of MV CBCT-based treatment planning for urgent radiation therapy: dosimetric accuracy of MV CBCT-based dose calculations.

Unlike scheduled radiotherapy treatments, treatment planning time and resources are limited for emergency treatments. Consequently, plans are often simple 2D image-based treatments that lag behind technical capabilities available for nonurgent radiotherapy. We have developed a novel integrated urgent workflow that uses onboard MV CBCT imaging for patient simulation to improve planning accuracy and reduce the total time for urgent treatments. This study evaluates both MV CBCT dose planning accuracy and novel urgent workflow feasibility for a variety of anatomic sites. We sought to limit local mean dose differences to less than 5% compared to conventional CT simulation. To improve dose calculation accuracy, we created separate Hounsfield unit-to-density calibration curves for regular and extended field-of-view (FOV) MV CBCTs. We evaluated dose calculation accuracy on phantoms and four clinical anatomical sites (brain, thorax/spine, pelvis, and extremities). Plans were created for each case and dose was calculated on both the CT and MV CBCT. All steps (simulation, planning, setup verification, QA, and dose delivery) were performed in one 30 min session using phantoms. The monitor units (MU) for each plan were compared and dose distribution agreement was evaluated using mean dose difference over the entire volume and gamma index on the central 2D axial plane. All whole-brain dose distributions gave gamma passing rates higher than 95% for 2%/2 mm criteria, and pelvic sites ranged between 90% and 98% for 3%/3 mm criteria. However, thoracic spine treatments produced gamma passing rates as low as 47% for 3%/3 mm criteria. Our novel MV CBCT-based dose planning and delivery approach was feasible and time-efficient for the majority of cases. Limited MV CBCT FOV precluded workflow use for pelvic sites of larger patients and resulted in image clearance issues when tumor position was far off midline. The agreement of calculated MU on CT and MV CBCT was acceptable for all treatment sites

Comparative Genomics of 9 Novel Paenibacillus Larvae Bacteriophages

American Foulbrood Disease, caused by the bacterium Paenibacillus larvae, is one of the most destructive diseases of the honeybee, Apis mellifera. Our group recently published the sequences of 9 new phages with the ability to infect and lyse P. larvae. Here, we characterize the genomes of these P. larvae phages, compare them to each other and to other sequenced P. larvae phages, and putatively identify protein function. The phage genomes are 38–45 kb in size and contain 68–86 genes, most of which appear to be unique to P. larvae phages. We classify P. larvae phages into 2 main clusters and one singleton based on nucleotide sequence identity. Three of the new phages show sequence similarity to other sequenced P. larvae phages, while the remaining 6 do not. We identified functions for roughly half of the P. larvae phage proteins, including structural, assembly, host lysis, DNA replication/metabolism, regulatory, and host-related functions. Structural and assembly proteins are highly conserved among our phages and are located at the start of the genome. DNA replication/metabolism, regulatory, and host-related proteins are located in the middle and end of the genome, and are not conserved, with many of these genes found in some of our phages but not others. All nine phages code for a conserved N-acetylmuramoyl-L-alanine amidase. Comparative analysis showed the phages use the “cohesive ends with 30 overhang” DNA packaging strategy. This work is the first in-depth study of P. larvae phage genomics, and serves as a marker for future work in this area

Comparing families of dynamic causal models

Mathematical models of scientific data can be formally compared using Bayesian model evidence. Previous applications in the biological sciences have mainly focussed on model selection in which one first selects the model with the highest evidence and then makes inferences based on the parameters of that model. This “best model” approach is very useful but can become brittle if there are a large number of models to compare, and if different subjects use different models. To overcome this shortcoming we propose the combination of two further approaches: (i) family level inference and (ii) Bayesian model averaging within families. Family level inference removes uncertainty about aspects of model structure other than the characteristic of interest. For example: What are the inputs to the system? Is processing serial or parallel? Is it linear or nonlinear? Is it mediated by a single, crucial connection? We apply Bayesian model averaging within families to provide inferences about parameters that are independent of further assumptions about model structure. We illustrate the methods using Dynamic Causal Models of brain imaging data