Cancer Patient and clinician acceptability and feasibility of a supportive care screening and referral process

Background: Incorporating supportive care into routine cancer care is an increasing priority for the multi-disciplinary team with growing evidence of its importance to patient-centred care. How to design and deliver a process which is appropriate for patients, clinicians and health services in rural areas needs further investigation. Objective: To (i) examine the patient and clinician acceptability and feasibility of incorporating a supportive care screening and referral process into routine cancer care in a rural setting, and (ii) explore any potential influences of patient variables on the acceptability of the process. Methods: A total of 154 cancer patients and 36 cancer clinicians across two rural areas of Victoria, Australia participated. During treatment visits, patients and clinicians participated in a supportive care process involving screening, discussion of problems, and provision of information and referrals. Structured questionnaires with open and closed questions were used to measure patient and clinician acceptability and feasibility. Results: Patients and clinicians found the supportive care process highly acceptable. Screening identified relevant patient problems (90%) and problems that may not have otherwise been identified (83%). The patient-clinician discussion helped patients realize help was available (87%) and enhanced clinician-patient rapport (72%). Patients received useful referrals to services (76%). Feasibility issues included timing of screening for newly diagnosed patients, privacy in discussing problems, clinician time and availability of referral options. No patient demographic or disease factors influenced acceptability or feasibility. Conclusions: Patients and clinicians reported high acceptability for the supportive care process, although mechanisms for incorporating the process into health care need to be further developed

Psychometric properties of implementation measures for public health and community settings and mapping of constructs against the Consolidated Framework for Implementation Research: a systematic review

Background: Recent reviews have synthesised the psychometric properties of measures developed to examine implementation science constructs in healthcare and mental health settings. However, no reviews have focussed primarily on the properties of measures developed to assess innovations in public health and community settings. This review identified quantitative measures developed in public health and community settings, examined their psychometric properties, and described how the domains of each measure align with the five domains and 37 constructs of the Consolidated Framework for Implementation Research (CFIR). Methods: MEDLINE, PsycINFO, EMBASE, and CINAHL were searched to identify publications describing the development of measures to assess implementation science constructs in public health and community settings. The psychometric properties of each measure were assessed against recommended criteria for validity (face/content, construct, criterion), reliability (internal consistency, test-retest), responsiveness, acceptability, feasibility, and revalidation and cross-cultural adaptation. Relevant domains were mapped against implementation constructs defined by the CFIR. Results: Fifty-one measures met the inclusion criteria. The majority of these were developed in schools, universities, or colleges and other workplaces or organisations. Overall, most measures did not adequately assess or report psychometric properties. Forty-six percent of measures using exploratory factor analysis reported >50 % of variance was explained by the final model; none of the measures assessed using confirmatory factor analysis reported root mean square error of approximation (<0.06) or comparative fit index (>0.95). Fifty percent of measures reported Cronbach’s alpha of <0.70 for at least one domain; 6 % adequately assessed test-retest reliability; 16 % of measures adequately assessed criterion validity (i.e. known-groups); 2 % adequately assessed convergent validity (r > 0.40). Twenty-five percent of measures reported revalidation or cross-cultural validation. The CFIR constructs most frequently assessed by the included measures were relative advantage, available resources, knowledge and beliefs, complexity, implementation climate, and other personal resources (assessed by more than ten measures). Five CFIR constructs were not addressed by any measure. Conclusions: This review highlights gaps in the range of implementation constructs that are assessed by existing measures developed for use in public health and community settings. Moreover, measures with robust psychometric properties are lacking. Without rigorous tools, the factors associated with the successful implementation of innovations in these settings will remain unknown

Submillimeter ALMA Observations of the Dense Gas in the Low-Luminosity Type-1 Active Nucleus of NGC 1097

We present the first 100 pc scale view of the dense molecular gas in the central ~ 1.3 kpc region of the type-1 Seyfert NGC 1097 traced by HCN (J=4-3) and HCO+ (J=4-3) lines afforded with ALMA band 7. This galaxy shows significant HCN enhancement with respect to HCO+ and CO in the low-J transitions, which seems to be a common characteristic in AGN environments. Using the ALMA data, we study the characteristics of the dense gas around this AGN and search for the mechanism of HCN enhancement. We find a high HCN (J=4-3) to HCO+ (J=4-3) line ratio in the nucleus. The upper limit of the brightness temperature ratio of HCN (v2=1^{1f}, J=4-3) to HCN (J=4-3) is 0.08, which indicates that IR pumping does not significantly affect the pure rotational population in this nucleus. We also find a higher HCN (J=4-3) to CS (J=7-6) line ratio in NGC 1097 than in starburst galaxies, which is more than 12.7 on the brightness temperature scale. Combined from similar observations from other galaxies, we tentatively suggest that this ratio appears to be higher in AGN-host galaxies than in pure starburst ones similar to the widely used HCN to HCO+ ratio. LTE and non-LTE modeling of the observed HCN and HCO+ lines using J=4-3 and 1-0 data from ALMA, and J=3-2 data from SMA, reveals a high HCN to HCO+ abundance ratio (5 < [HCN]/[HCO+] < 20: non-LTE analysis) in the nucleus, and that the high-J lines (J=4-3 and 3-2) are emitted from dense (10^{4.5} < n_H2 [/cc] < 10^6), hot (70 < Tkin [K] < 550) regions. Finally we propose that the high temperature chemistry is more plausible to explain the observed enhanced HCN emission in NGC 1097 than the pure gas phase PDR/XDR chemistry.Comment: 28 pages, 17 figures, 10 tables. Accepted to PAS

ALMA Observations of the Submillimeter Dense Molecular Gas Tracers in the Luminous Type-1 Active Nucleus of NGC 7469

We present ALMA Cycle 1 observations of the central kpc region of the luminous type-1 Seyfert galaxy NGC 7469 with unprecedented high resolution (0.5$"$ $\times$ 0.4$"$ = 165 pc $\times$ 132 pc) at submillimeter wavelengths. Utilizing the wide-bandwidth of ALMA, we simultaneously obtained HCN(4-3), HCO$^+$(4-3), CS(7-6), and partially CO(3-2) line maps, as well as the 860 $\mu$m continuum. The region consists of the central $\sim$ 1$"$ component and the surrounding starburst ring with a radius of $\sim$ 1.5$"$-2.5$"$. Several structures connect these components. Except for CO(3-2), these dense gas tracers are significantly concentrated towards the central $\sim$ 1$"$, suggesting their suitability to probe the nuclear regions of galaxies. Their spatial distribution resembles well those of centimeter and mid-infrared continuum emissions, but it is anti-correlated with the optical one, indicating the existence of dust obscured star formation. The integrated intensity ratios of HCN(4-3)/HCO$^+$(4-3) and HCN(4-3)/CS(7-6) are higher at the AGN position than at the starburst ring, which is consistent to our previous findings (submm-HCN enhancement). However, the HCN(4-3)/HCO$^+$(4-3) ratio at the AGN position of NGC 7469 (1.11$\pm$0.06) is almost half of the corresponding value of the low-luminosity type-1 Seyfert galaxy NGC 1097 (2.0$\pm$0.2), despite the more than two orders of magnitude higher X-ray luminosity of NGC 7469. But the ratio is comparable to that of the close vicinity of the AGN of NGC 1068 ($\sim$ 1.5). Based on these results, we speculate that some other heating mechanisms than X-ray (e.g., mechanical heating due to AGN jet) can contribute significantly for shaping the chemical composition in NGC 1097.Comment: Fixed typos in the title. 15 pages, 8 figures, 4 tables: accepted for publication in ApJ. Comments welcom

Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study

Objective: Diagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. We report a bespoke diagnostic pathway to assess how best to combine clinical history and faecal calprotectin (FCP) for early diagnosis and efficient resource utilisation. Methods: A rapid-access pathway was implemented for suspected IBD patients referred outside urgent ‘two-week wait’ criteria. Patients were triaged using symptoms and FCP. A 13-point symptom history was taken prediagnosis and clinical indices, including repeat FCP, collected prospectively. Results: Of 767 patients (January 2021–August 2023), 423 were diagnosed with IBD (208 Crohn’s disease (CD), 215 ulcerative colitis (UC)). Most common symptoms in CD were abdominal pain (84%), looser stools (84%) and fatigue (79%) and in UC per-rectal bleeding (94%), urgency (82%) and looser stools (81%). Strongest IBD predictors were blood mixed with stools (CD OR 4.38; 95% CI 2.40–7.98, UC OR 33.68; 15.47–73.33) and weight loss (CD OR 3.39; 2.14–5.38, UC OR 2.33; 1.37–4.00). Repeat FCP testing showed reduction from baseline in non-IBD. Both measurements &gt;100 µg/g (area under the curve (AUC) 0.800) and &gt;200 µg/g (AUC 0.834) collectively predicted IBD. However, a second value ≥220 µg/g considered alone, regardless of the first result, was more accurate (Youden’s index 0.735, AUC 0.923). Modelling symptoms with FCP increased AUC to 0.947. Conclusion: Serial FCP measurement prevents unnecessary colonoscopy. Two FCPs &gt;200 µg/g could stream patients direct to colonoscopy, with two &gt;100 µg/g prompting clinic review. A second result ≥220 µg/g was more accurate than dual-result thresholds. Coupling home FCP testing with key symptoms may form the basis of effective self-referral pathways

Dietary organic zinc promotes growth, immune response and antioxidant capacity by modulating zinc signaling in juvenile Pacific white shrimp (Litopenaeus vannamei)

An 8-week feeding trial was conducted to evaluate effects of dietary organic zinc (zinc amino acid chelate) on growth performance, mineral bioaccumulation in whole body, hepatopancreas and carapace, innate immune response and antioxidant capacity of juvenile Pacific white shrimp Litopenaeus vannamei. Five isonitrogenous and isolipidic diets were formulated to contain different zinc levels of 46.4 (basal diet), 65.5, 85.9, 108.4 and 130.6 mg kg−1. Dietary zinc level significantly influenced growth and feed utilization, with the lowest weight gain and highest feed conversion ratio observed in shrimp fed the basal diet. The optimal dietary zinc requirement was estimated to be 104.8 mg kg-1 for juvenile Pacific white shrimp. Shrimp fed the diet containing 130.6 mg kg−1 Zn had the highest zinc concentration in hepatopancreas and carapace, but there were no significant differences in calcium or phosphorus concentration in tissues. Dietary Zn increased the activities of lysozyme, alkaline phosphatase and polyphenol oxidase in hepatopancreas. Shrimp fed the diets supplemented with zinc had significantly higher activity of Cu/Zn SOD and lower content of malondialdehyde in hepatopancreas. The expression levels of toll, imd, lzm, proPO and alp involved in immunity and Cu/Zn sod related to oxidation resistance were up-regulated. Zinc also promoted the expression levels of mt and mtf-1, and up-regulated the expression of SLC39 family genes (zip3, zip9, zip11, zip14) in hepatopancreas. These data provided novel insights in the potential mechanism of organic zinc-induced enhancement of immunity and antioxidant capacity in Pacific white shrimp

The Linkage Outcomes of a Large-scale, Rapid Transfer of HIV-infected Patients From Hospital-based to Community-based Clinics in South Africa

Background: President's Emergency Plan for AIDS Relief (PEPFAR) funding changes have resulted in human immunodeficiency virus (HIV) clinic closures. We evaluated linkage to care following a large-scale patient transfer from a PEPFAR-funded, hospital-based HIV clinic to government-funded, community-based clinics in Durban. Methods: All adults were transferred between March and June 2012. Subjects were surveyed 5–10 months post-transfer to assess self-reported linkage to the target clinic. We validated self-reports by auditing records at 8 clinics. Overall success of transfer was estimated using linkage to care data for both reached and unreached subjects, adjusted for validation results. Results: Of the 3913 transferred patients, 756 (19%) were assigned to validation clinics; 659 (87%) of those patients were reached. Among those reached, 468 (71%) had a validated clinic record visit. Of the 46 who self-reported attending a different validation clinic than originally assigned, 39 (85%) had a validated visit. Of the 97 patients not reached, 59 (61%) had a validated visit at their assigned clinic. Based on the validation rates for reached and unreached patients, the estimated success of transfer for the cohort overall was 82%. Conclusions: Most patients reported successful transfer to a community-based clinic, though a quarter attended a different clinic than assigned. Validation of attendance highlights that nearly 20% of patients may not have linked to care and may have experienced a treatment interruption. Optimizing transfers of HIV care to community sites requires collaboration with receiving clinics to ensure successful linkage to care

Comparative effectiveness of initial computed tomography and invasive coronary angiography in women and men with stable chest pain and suspected coronary artery disease: multicentre randomised trial

To assess the comparative effectiveness of computed tomography and invasive coronary angiography in women and men with stable chest pain suspected to be caused by coronary artery disease

16p11.2 600 kb Duplications confer risk for typical and atypical Rolandic epilepsy

Rolandic epilepsy (RE) is the most common idiopathic focal childhood epilepsy. Its molecular basis is largely unknown and a complex genetic etiology is assumed in the majority of affected individuals. The present study tested whether six large recurrent copy number variants at 1q21, 15q11.2, 15q13.3, 16p11.2, 16p13.11 and 22q11.2 previously associated with neurodevelopmental disorders also increase risk of RE. Our association analyses revealed a significant excess of the 600 kb genomic duplication at the 16p11.2 locus (chr16: 29.5-30.1 Mb) in 393 unrelated patients with typical (n = 339) and atypical (ARE; n = 54) RE compared with the prevalence in 65 046 European population controls (5/393 cases versus 32/65 046 controls; Fisher's exact test P = 2.83 × 10−6, odds ratio = 26.2, 95% confidence interval: 7.9-68.2). In contrast, the 16p11.2 duplication was not detected in 1738 European epilepsy patients with either temporal lobe epilepsy (n = 330) and genetic generalized epilepsies (n = 1408), suggesting a selective enrichment of the 16p11.2 duplication in idiopathic focal childhood epilepsies (Fisher's exact test P = 2.1 × 10−4). In a subsequent screen among children carrying the 16p11.2 600 kb rearrangement we identified three patients with RE-spectrum epilepsies in 117 duplication carriers (2.6%) but none in 202 carriers of the reciprocal deletion. Our results suggest that the 16p11.2 duplication represents a significant genetic risk factor for typical and atypical R

Astrophysics with the Laser Interferometer Space Antenna

Laser Interferometer Space Antenna (LISA) will be a transformative experiment for gravitational wave astronomy as it will offer unique opportunities to address many key astrophysical questions in a completely novel way. The synergy with ground-based and other space-based instruments in the electromagnetic domain, by enabling multi-messenger observations, will add further to the discovery potential of LISA. The next decade is crucial to prepare the astrophysical community for LISA's first observations. This review outlines the extensive landscape of astrophysical theory, numerical simulations, and astronomical observations that are instrumental for modeling and interpreting the upcoming LISA datastream. To this aim, the current knowledge in three main source classes for LISA is reviewed: ultra-compact stellar-mass binaries, massive black hole binaries, and extreme or intermediate mass ratio inspirals. The relevant astrophysical processes and the established modeling techniques are summarized. Likewise, open issues and gaps in our understanding of these sources are highlighted, along with an indication of how LISA could help make progress in the different areas. New research avenues that LISA itself, or its joint exploitation with studies in the electromagnetic domain, will enable, are also illustrated. Improvements in modeling and analysis approaches, such as the combination of numerical simulations and modern data science techniques, are discussed. This review is intended to be a starting point for using LISA as a new discovery tool for understanding our Universe