How genomic information is accessed in clinical practice: an electronic survey of UK general practitioners.

Genomic technologies are having an increasing impact across medicine, including primary care. To enable their wider adoption and realize their potential, education of primary health-care practitioners will be required. To enable the development of such resources, understanding where GPs currently access genomic information is needed. One-hundred fifty-nine UK GPs completed the survey in response to an open invitation, between September 2017 and September 2018. Questions were in response to 4 clinical genomic scenarios, with further questions exploring resources used for rare disease patients, direct-to-consumer genetic testing and collecting a family history. Respondents were most commonly GP principals (independent GPs who own their clinic) (64.8%), aged 35-49 years (54%), worked as a GP for more than 15 years (44%) and practiced within suburban locations (typically wealthier) (50.3%). The most popular 'just in time' education source for all clinical genomic scenarios were online primary care focussed resources with general Internet search engines also popular. For genomic continuous medical education, over 70% of respondents preferred online learning. Considering specific scenarios, local guidelines were a popular resource for the familial breast cancer scenario. A large proportion (41%) had not heard of Genomics England's 100,000 genome project. Few respondents (4%) would access rare disease specific Internet resources (Orphanet, OMIM). Twenty-five percent of respondents were unsure how to respond to a direct-to-consumer commercial genetic test query, with 41% forwarding such queries to local genetic services. GPs require concise, relevant, primary care focussed resources in trusted and familiar online repositories of information. Inadequate genetic education of GPs could increase burden on local genetic services

AMCTD: Adaptive Mobility of Courier nodes in Threshold-optimized DBR Protocol for Underwater Wireless Sensor Networks

In dense underwater sensor networks (UWSN), the major confronts are high error probability, incessant variation in topology of sensor nodes, and much energy consumption for data transmission. However, there are some remarkable applications of UWSN such as management of seabed and oil reservoirs, exploration of deep sea situation and prevention of aqueous disasters. In order to accomplish these applications, ignorance of the limitations of acoustic communications such as high delay and low bandwidth is not feasible. In this paper, we propose Adaptive mobility of Courier nodes in Threshold-optimized Depth-based routing (AMCTD), exploring the proficient amendments in depth threshold and implementing the optimal weight function to achieve longer network lifetime. We segregate our scheme in 3 major phases of weight updating, depth threshold variation and adaptive mobility of courier nodes. During data forwarding, we provide the framework for alterations in threshold to cope with the sparse condition of network. We ultimately perform detailed simulations to scrutinize the performance of our proposed scheme and its comparison with other two notable routing protocols in term of network lifetime and other essential parameters. The simulations results verify that our scheme performs better than the other techniques and near to optimal in the field of UWSN.Comment: 8th International Conference on Broadband and Wireless Computing, Communication and Applications (BWCCA'13), Compiegne, Franc

An epidemic of Dengue fever in Karachi--associated clinical manifestations

Dengue is a mosquito borne disease with worldwide distribution. Depending on virulence factors and host immune status, infection can manifest as a severe but non fatal viral syndrome or a rapidly progressive and a frequently fatal haemorrhagic fever. During the course of an outbreak of viral fever in Karachi, Pakistan from June, 1994 to September, 1995, we studied 145 cases admitted at the Aga Khan University Hospital. 43% of the cases were between the age group of 20-30 years, majority of these being male (75%). Amongst the clinical signs and symptoms, the most frequent findings were fever, vomiting and abdominal pain. Spontaneous hemorrhagic manifestations occurred in 66 patients and of these petechiae and mucosal bleed were the commonest, that is, 42% and 38% respectively. At presentation thrombocytopenia (platelet count \u3c or = 50,000) per cubic millimeter) was present in 78%, leucopenia (white cell count \u3c 4,000 per cubic millimeter) in 34%. Apart from one patient who died from hemorrhagic shock on the 5th day of admission, the remaining patients recovered and their platelet counts normalized on an average in 9 days. This is the first reported epidemic in Karachi of dengue infection

Ground state magnetic structure of Mn3_3Ge

We have used spherical neutron polarimetry to investigate the magnetic structure of the Mn spins in the hexagonal semimetal Mn$_3$Ge, which exhibits a large intrinsic anomalous Hall effect. Our analysis of the polarimetric data finds a strong preference for a spin structure with $E_{1g}$ symmetry relative to the $D_{6h}$ point group. We show that weak ferromagnetism is an inevitable consequence of the symmetry of the observed magnetic structure, and that sixth order anisotropy is needed to select a unique ground state

Orbital occupation and magnetic moments of tetrahedrally coordinated iron in CaBaFe4O7

CaBaFe4O7 is a mixed-valent transition metal oxide having both Fe2+ and Fe3+ ions in tetrahedral coordination. Here we characterize its magnetic properties by magnetization measurements and investigate its local electronic structure using soft x-ray absorption spectroscopy at the Fe L2,3 edges, in combination with multiplet cluster and spin-resolved band structure calculations. We found that the Fe2+ ion in the unusual tetrahedral coordination is Jahn-Teller active with the high-spin e^2 (up) t2^3 (up) e^1 (down) configuration having a x^2-y^2-like electron for the minority spin. We deduce that there is an appreciable orbital moment of about L_z=0.36 caused by multiplet interactions, thereby explaining the observed magnetic anisotropy. CaBaFe4O7, a member of the '114' oxide family, offers new opportunities to explore charge, orbital and spin physics in transition metal oxides

Crystal and magnetic structure of the oxypnictide superconductor LaO(1-x)FxFeAs: evidence for magnetoelastic coupling

High-resolution and high-flux neutron as well as X-ray powder-diffraction experiments were performed on the oxypnictide series LaO(1-x)FxFeAs with 0<x<0.15 in order to study the crystal and magnetic structure. The magnetic symmetry of the undoped compound corresponds to those reported for ReOFeAs (with Re a rare earth) and for AFe2As2 (A=Ba, Sr) materials. We find an ordered magnetic moment of 0.63(1)muB at 2 K in LaOFeAs, which is significantly larger than the values previously reported for this compound. A sizable ordered magnetic moment is observed up to a F-doping of 4.5% whereas there is no magnetic order for a sample with a F concentration of x=0.06. In the undoped sample, several interatomic distances and FeAs4 tetrahedra angles exhibit pronounced anomalies connected with the broad structural transition and with the onset of magnetism supporting the idea of strong magneto-elastic coupling in this material.Comment: 8 pages, 7 figures, regular articl

AC and DC House Wiring Efficiency Estimations Using a Fast Extensive Measurements Approach

DC-based appliances are exponentially increasing in the present market. This scenario opens the opportunity to utilize the DC electricity produced by the PV panels directly without going through the conversion stages. Due to high penetration of DC electricity sources, it is timely to utilize DC electricity directly. Several research works have been reported in the literature to experimentally test and compare AC and DC wiring options. Accurate and precise experimental measurements are vital to establish a sound theoretical basis. However, this is difficult due to cost and time constraints. Therefore, to avoid costly measurements, this paper develops a mathematical model based on measurements on selected AC and DC wiring at four voltage levels (12 V DC, 24 V DC, 48 V DC, and 230 V AC). A digital simulation calibration using DigSilent is conducted to validate the proposed mathematical model. This paper proposed to utilize the simulation calibration approach that is a cost-effective and timesaving option to perform extensive measurements accurately

Gestational diabetes in a developing country, experience of screening at the Aga Khan University Medical Centre, Karachi

In order to determine the prevalence of glucose intolerance in pregnancy, 1267 consecutive women attending the antenatal clinic of the Aga Khan University Medical Centre were subjected to a 75 g glucose challenge followed 2 hr later by plasma glucose determination irrespective of gestation on the first antenatal visit. The test was repeated at 28-32 weeks of gestation if the patients had an abnormal initial screen at less than 28 weeks gestation and a normal glucose tolerance test on diagnostic follow-up and for those who had a risk factor for gestational diabetes and a normal initial screen at less than 28 weeks gestation. The glucose challenge test was abnormal (2 hr plasma glucose greater than 140 mg%) in 8.6% of the screened population. Follow-up oral glucose tolerance test on these patients revealed a prevalence of 3.2% of gestational diabetes and 1.9% of impaired glucose tolerance test based on the modified O\u27Sullivan criteria. Improvement in cost effectiveness of screening programmes was adjudged possible by avoiding glucose tolerance tests in patients with 2 hr plasma glucose value of greater than 170 mg% after a 75 g oral glucose challenge for screening

Experimental Evidence for the Spiral Spin Liquid in LiYbO2_2

Spiral spin liquids are an exotic class of correlated paramagnets with an enigmatic magnetic ground state composed of a degenerate manifold of fluctuating spin spirals. Experimental realisations of the spiral spin liquid are scarce, mainly due to the prominence of structural distortions in candidate materials that can trigger order-by-disorder transitions to more conventionally ordered magnetic ground states. Expanding the pool of candidate materials that may host a spiral spin liquid is therefore crucial to realising this novel magnetic ground state and understanding its robustness against perturbations that arise in real materials. Here, we show that the material LiYbO$_2$ is the first experimental realisation of a spiral spin liquid predicted to emerge from the $J_1$-$J_2$ Heisenberg model on an elongated diamond lattice. Through a complementary combination of high-resolution and diffuse neutron magnetic scattering studies on a polycrystalline sample, we demonstrate that LiYbO$_2$ fulfils the requirements for the experimental realisation of the spiral spin liquid and reconstruct single-crystal diffuse neutron magnetic scattering maps that reveal continuous spiral spin contours -- a characteristic experimental hallmark of this exotic magnetic phase.Comment: 6 pages, 5 figures, accepted PR

Diversity, urban space and the right to the provincial city

Using three vignettes of the same physical space this article contributes to understanding of how the right to the city is contested in provincial England in the early twenty-first century. Oral history and ethnographic material gathered in Peterborough between 2010 and 2012 are drawn on to shed new light on the politics of diversity and urban space. This highlights the multiple place attachments and trans-spatial practices of all residents, including the white ethnic majority, as well as contrasting forms of active intervention in space with their different temporalities and affective intensities. The article carries its own diversity politics, seeking to reduce the harm done by racism through challenging the normalisation of the idea of a local, indigenous population, left out by multiculturalism. It simultaneously raises critical questions about capitalist regeneration strategies in terms of their impact both on class inequality and on the environment