Shared decision-making in ongoing outpatient psychiatric treatment

Objective: Research on patient involvement in decision-making in psychiatry has focused on first encounters. This study investigated what decisions are made, level of patient involvement and factors influencing patient involvement in ongoing outpatient visits. Methods:72 visits conducted by 20 psychiatrists were video recorded. Patients had a diagnosis of depression or schizophrenia. Results: On average, there was one medication related and one other decision per visit. Some psychiatrists involved patients more in decisions, as did female psychiatrists. Involvement was lower when patients had more negative symptoms. Conclusion: Involvement in decision-making appears to be influenced by the individual psychiatrist and specific symptoms but not visit length. Practice implications:It is noteworthy that patient involvement is not influenced by length of the visit given that this would be a barrier in busy clinical practice. The next step would be to identify the communication patterns of psychiatrists who involve patients more in decision-making

Impact of Formulation and Slurry Properties on Lithium-ion Electrode Manufacturing

The characteristics and performance of lithium-ion batteries typically rely on the precise combination of materials in their component electrodes. Understanding the impact of this formulation and the interdependencies between each component is critical in optimising cell performance. Such optimisation is difficult as the cost and effort for the myriad of possible combinations is too high. This problem is addressed by combining a design of experiments (DoE) and advanced statistical machine learning approach with comprehensive experimental characterisation of electrode slurries and coatings. An industry relevant graphite anode system is used, and with the aid of DoE, less than 30 experiments are defined to map impact of different weight fractions of active material (80–96 wt%), conductive additive (Carbon Black at 1–10 wt%) and a two-component binder system (Carboxymethyl Cellulose (CMC) at 1–3 wt% and Styrene Butadiene Rubber (SBR), at 1–7 wt%). Using Explainable Machine Learning (XML) methods, correlations between the formulation, slurry weight percentage (30–50 wt% in water) and coating speed (1–15 m/min) are quantified. Slurry viscosity, while known to depend on the CMC concentration, is also heavily influenced by carbon black and SBR when at high concentration, as is common in research. Viscosity increasing components also improve adhesion, by improving dispersion and hindering binder migration. Conductivity of the coating on current collector is sensitive to the current collector-coating interface, which makes it a highly useful probe. Improvements in cell capacity are observed with higher viscosity formulations (High weight percentage, CMC content), attributed to reduction in migration and slumping of the slurry on the current collector. SBR had a negative impact at any concentration due to its insulating nature, and carbon black reduces gravimetric capacity when included at high concentrations. The insights from this study facilitate the formulation optimisation of electrodes providing improved slurry design rules for future high performance electrode manufacturing

Helium ion microscope – secondary ion mass spectrometry for geological materials

The helium ion microscope (HIM) is a focussed ion beam instrument with unprecedented spatial resolution for secondary electron imaging but has traditionally lacked microanalytical capabilities. With the addition of the secondary ion mass spectrometry (SIMS) attachment, the capabilities of the instrument have expanded to microanalysis of isotopes from Li up to hundreds of atomic mass units, effectively opening up the analysis of all natural and geological systems. However, the instrument has thus far been underutilised by the geosciences community, due in no small part to a lack of a thorough understanding of the quantitative capabilities of the instrument. Li represents an ideal element for an exploration of the instrument as a tool for geological samples, due to its importance for economic geology and a green economy, and the difficult nature of observing Li with traditional microanalytical techniques. Also Li represents a “best-case” scenario for isotopic measurements. Here we present details of sample preparation, instrument sensitivity, theoretical, and measured detection limits for both elemental and isotopic analysis as well as practicalities for geological sample analyses of Li alongside a discussion of potential geological use cases of the HIM–SIMS instrument

Twelve Tips for Medical Students starting Clinical Placements in the United Kingdom

Transitioning from the pre-clinical to clinical years at medical school can be challenging and overwhelming. This paper aims to utilise the experience of healthcare professionals to provide tips for medical students to consider in order to maximise their learning opportunities. Before starting a placement, it is highly encouraged that you familiarise yourself with the curriculum, remember to bring your essentials and dress appropriately. During your placement, ensure good attendance keeping, introduce yourself to the team, manage your time well, engage in self-directed learning, ask questions to other doctors, interact with allied health care professionals and follow the patient’s journey from admission to discharge. It is also key to be wary of university requirements, regularly practice history-taking and clinical examination and examination style questions. Prioritise a suitable work-life balance by enjoying hobbies and extra-curricular activities in order to avoid burn-out. These tips should ensure medical students make the most of their clinical placements as well as making it a memorable and enjoyable experience

Fresh and hardened properties of concrete containing effective microorganisms

Nowadays, concrete is popularly used in many areas and applications in construction industry. If designed and manufactured properly it can be one of the most durable construction materials. However, during the life span of the structure the surrounding environment where the structure is built may pose long-term durability problem to concrete such as cracks and corrosion of steel reinforcement. Thus, researchers around the world continue searching for any possible means to improve concrete qualities. This paper presents study on the effects of Effective Microorganism on fresh and hardened properties of concrete. The percentage of Effective Microorganisms (EM) used in this study was 10% and incorporated in the concrete mix by replacing the water content. In this research work, a number of control and EM concrete cube samples were cast, cured in water and tested at the ages of 3, 7 and 28 days. The workability of fresh concrete was measured through the slump test. The effect of EM on hardened concrete was assessed through compression test and ultrasonic pulse velocity (UPV) test. The experimental result shows that the workability of concrete with EM was 67% higher than the control concrete. This may indicate that the EM has the potential to be used as workability enhancer. In terms of compressive strength, the EM concrete recorded 8% higher strength at 28 days compared to concrete without EM. In addition, the early strength of EM concrete was found to be higher by 41% and 27% at 3 and 7 days compared to control, respectively. The UPV result for EM concrete also shows higher value than control concrete indicating denser concrete. All experimental results indicated that the use of EM has positive effects on concrete properties

The GALNT9, BNC1 and CCDC8 genes are frequently epigenetically dysregulated in breast tumours that metastasise to the brain.

Tumour metastasis to the brain is a common and deadly development in certain cancers; 18-30 % of breast tumours metastasise to the brain. The contribution that gene silencing through epigenetic mechanisms plays in these metastatic tumours is not well understood

Dityrosine cross-links are present in alzheimer's disease-derived Tau Oligomers and Paired Helical Filaments (PHF) which Promotes the stability of the PHF-core Tau (297–391) in vitro

A characteristic hallmark of Alzheimer's Disease (AD) is the pathological aggregation and deposition of tau into paired helical filaments (PHF) in neurofibrillary tangles (NFTs). Oxidative stress is an early event during AD pathogenesis and is associated with tau-mediated AD pathology. Oxidative environments can result in the formation of covalent dityrosine crosslinks that can increase protein stability and insolubility. Dityrosine cross-linking has been shown in Aβ plaques in AD and α-synuclein aggregates in Lewy bodies in ex vivo tissue sections, and this modification may increase the insolubility of these aggregates and their resistance to degradation. Using the PHF-core tau fragment (residues 297 – 391) as a model, we have previously demonstrated that dityrosine formation traps tau assemblies to reduce further elongation. However, it is unknown whether dityrosine crosslinks are found in tau deposits in vivo in AD and its relevance to disease mechanism is unclear. Here, using transmission electron microscope (TEM) double immunogold-labelling, we reveal that neurofibrillary NFTs in AD are heavily decorated with dityrosine crosslinks alongside tau. Single immunogold-labelling TEM and fluorescence spectroscopy revealed the presence of dityrosine on AD brain-derived tau oligomers and fibrils. Using the tau (297–391) PHF-core fragment as a model, we further showed that prefibrillar tau species are more amenable to dityrosine crosslinking than tau fibrils. Dityrosine formation results in heat and SDS stability of oxidised prefibrillar and fibrillar tau assemblies. This finding has implications for understanding the mechanism governing the insolubility and toxicity of tau assemblies in vivo

Biosynthesis of silver nanoparticles from Cymbopogon citratus leaf extract and evaluation of their antimicrobial properties

Background: Silver nanoparticles (AgNPs) are toxic to microorganisms and can potentially kill multidrug-resistant bacteria. Nanoparticles can be synthesized in many ways, such as physical or chemical methods. Recently, it has been found that plant molecules can perform the same reduction reactions necessary for the production of nanoparticles but in a much more efficient way. Results: Here, green chemistry was employed to synthesize AgNPs using leaf extracts of Cymbopogon citratus. The effects of different parameters such as temperature, pH, and the volume of plant extract were also tested using their absorbance pattern at different wavelengths. The Surface Plasmon Resonance (SPR) changed with the changes in parameters. Changes in temperature from 20 °C to 60 °C have changed the highest absorbance from 0.972 to 3.893 with an SPR of 470 nm. At higher pH (11.1), the particles become highly unstable and have irregular shapes and sizes. The peak shifts to the right at a lower pH level (3.97), indicating a smaller but unstable compound. We have also investigated the effect of the volume of plant extracts on the reaction time. The sample with the highest amount of plant extract showed the most absorbance with a value of 0.963 at λmax, calculated to be 470 nm. The total formation of the AgNPs was observed visually with a color change from yellow to brownish-black. UV-visible spectroscopy was used to monitor the quantitative formation of AgNPs, showing a signature peak in absorbance between 400 and 500 nm. We have estimated the size of the nanoparticles as 47 nm by comparing the experimental data with the theoretical value using Mieplot. The biosynthesized AgNPs showed enhanced antibacterial activity against several multidrug-resistant bacteria, determined based on the minimal inhibitory concentration and zone of inhibition. Conclusion: The findings of this study indicate that an aqueous extract of C. citratus can synthesize AgNPs when silver nitrate is used as a precursor, and AgNPs act as antimicrobial property enhancers, which can be used to treat antibiotic-resistant bacteria. Hence, mass production and green synthesis of AgNPs from C. citratus will be able to increase the overall health of the general population. Moreover, it will enormously reduce the costs for drug development and provide employment options in the remotely located source areas. Finally, our findings will influence further studies in this field to better understand the properties and applications of AgNPs and ultimately contribute to improving planetary health by increasing immunity with high biocompatibility and less drug toxicity

Status Update and Interim Results from the Asymptomatic Carotid Surgery Trial-2 (ACST-2)

Objectives: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. Methods: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. Results: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical treatment. For 691 patients undergoing intervention with at least 1-month follow-up and Rankin scoring at 6 months for any stroke, the overall serious cardiovascular event rate of periprocedural (within 30 days) disabling stroke, fatal myocardial infarction, and death at 30 days was 1.0%. Conclusions: Early ACST-2 results suggest contemporary carotid intervention for asymptomatic stenosis has a low risk of serious morbidity and mortality, on par with other recent trials. The trial continues to recruit, to monitor periprocedural events and all types of stroke, aiming to randomize up to 5,000 patients to determine any differential outcomes between interventions. Clinical trial: ISRCTN21144362. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved

Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial

Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy. Methods: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388. Findings: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67–1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05–3·16, p<0·0001). Interpretation: Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice