Negotiating relevance in pre-operative assessments

Preoperative assessments provide an essential clinical risk assessment aimed at identifying patient risks and requirements prior to surgery. As such they require effective and sensitive information-gathering skills. In addition to physical examination, the preoperative assessment includes a series of routine questions assessing a patient's fitness for surgery. These questions are typically designed to elicit minimal, ‘no problem’ responses, but patients sometimes produce expanded responses that extend beyond the projected information. Our analysis reveals that troubles-telling is often invoked by both nurses and patients as an effective, patient-centred resource for negotiating the medical relevance of patients' concerns in these contexts

Mapping Lyman Continuum escape in Tololo 1247-232

Low redshift, spatially resolved Lyman continuum (LyC) emitters allow us to clarify the processes for LyC escape from these starburst galaxies. We use Hubble Space Telescope (HST) WFC3 and ACS imaging of the confirmed low-redshift LyC emitter Tol 1247-232 to study the ionization structure of the gas and its relation to the ionizing star clusters. We perform ionization parameter mapping (IPM) using [O III]4959, 5007 and [O II]3727 imaging as the high- and low-ionization tracers, revealing broad, large-scale, optically thin regions originating from the center, and reaching the outskirts of the galaxy, consistent with LyC escape. We carry out stellar population synthesis modeling of the 26 brightest clusters using our HST photometry. Combining these data with the nebular photometry, we find a global LyC escape fraction of f_esc = 0.12, with uncertainties also consistent with zero escape and with all measured f_esc values for this galaxy. Our analysis suggests that, similar to other candidate LyC emitters, a two-stage starburst has taken place in this galaxy, with a 12 Myr old, massive, central cluster likely having pre-cleared regions in and around the center, and the second generation of 2 - 4 Myr old clusters dominating the current ionization, including some escape from the galaxy.Comment: Accepted for publication in Ap

Why affiliation matters: A conversation analysis of complaints calls to the NHS

Callers making a complaint share their negative experience in complaint narratives that make relevant affiliation from an operator. We examined how call handlers' language choices affect both the progress of the call and the stance of the caller. We identified episodes where affiliation is displayed or noticeably absent in a dataset of 95 complaints calls to the NHS. Two single cases were closely examined using conversation analysis. Affiliation at sequentially relevant moments in conversation helps progress the call and de-escalate the complaint while the absence or misplacement of affiliation may lead to escalation. The latter recurringly involves blaming whilst de-escalation includes practices that diffuse blame. Early intervention in the form of affiliation to the 'hurt' component and the reasoning of the complaint is essential to de-escalation. Our analysis revealed three key functions of affiliation in complaints calls: 1) ratifying the reasonableness of the complaint; 2) progressing the institutional requirements of the call; 3) de-escalating the complaint. Call handlers should listen for callers' cues for legitimization of the complainability of their concerns and seek to provide responses that express affiliation. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

Photochemical modelling of atmospheric oxygen levels confirms two stable states

This work was supported by the European Research Council (ERC) under the European Union's Horizon 2020 Research and Innovation programme (grant no. 678812 awarded to M.W.C).Various proxies and numerical models have been used to constrain O2 levels over geological time, but considerable uncertainty remains. Previous investigations using 1-D photochemical models have predicted how O3 concentrations vary with assumed ground-level O2 concentrations, and indicate how the ozone layer might have developed over Earth history. These classic models have utilised the numerical simplification of fixed mixing ratio boundary conditions. Critically, this modelling assumption requires verification that predicted fluxes of biogenic and volcanic gases are realistic, but also that the resulting steady states are in fact stable equilibrium solutions against trivial changes in flux. Here, we use a 1-D photochemical model with fixed flux boundary conditions to simulate the effects on O3 and O2 concentrations as O2 (and CH4) fluxes are systematically varied. Our results suggest that stable equilibrium solutions exist for trace- and high-O2/O3 cases, separated by a region of instability. In particular, the model produces few stable solutions with ground O2 mixing ratios between 6×10-7 and 2×10-3 (3×10-6 and 1% of present atmospheric levels). A fully UV-shielding ozone layer only exists in the high-O2 states. Our atmospheric modelling supports prior work suggesting a rapid bimodal transition between reducing and oxidising conditions, and proposes Proterozoic oxygen levels higher than some recent proxies suggest. We show that the boundary conditions of photochemical models matter, and should be chosen and explained with care.Publisher PDFPeer reviewe

Nitric oxide treatments as adjuncts to reperfusion in acute myocardial infarction: a systematic review of experimental and clinical studies

Unmodified reperfusion therapy for acute myocardial infarction (AMI) is associated with irreversible myocardial injury beyond that sustained during ischemia. Studies in experimental models of ischemia/reperfusion and in humans undergoing reperfusion therapy for AMI have examined potential beneficial effects of nitric oxide (NO) supplemented at the time of reperfusion. Using a rigorous systematic search approach, we have identified and critically evaluated all the relevant experimental and clinical literature to assess whether exogenous NO given at reperfusion can limit infarct size. An inclusive search strategy was undertaken to identify all in vivo experimental animal and clinical human studies published in the period 1990–2014 where NO gas, nitrite, nitrate or NO donors were given to ameliorate reperfusion injury. Articles were screened at title and subsequently at abstract level, followed by objective full text analysis using a critical appraisal tool. In twenty-one animal studies, all NO treatments except nitroglycerin afforded protection against measures of reperfusion injury, including infarct size, creatinine kinase release, neutrophil accumulation and cardiac dysfunction. In three human AMI RCT’s, there was no consistent evidence of infarct limitation associated with NO treatment as an adjunct to reperfusion. Despite experimental evidence that most NO treatments can reduce infarct size when given as adjuncts to reperfusion, the value of these interventions in clinical AMI is unproven. Our study raises issues for the design of further clinical studies and emphasises the need for improved design of animal studies to reflect more accurately the comorbidities and other confounding factors seen in clinical AMI

Fully coupled photochemistry of the deuterated ionosphere of Mars and its effects on escape of H and D

Although deuterium (D) on Mars has received substantial attention, the deuterated ionosphere remains relatively unstudied. This means that we also know very little about non-thermal D escape from Mars, since it is primarily driven by excess energy imparted to atoms produced in ion-neutral reactions. Most D escape from Mars is expected to be non-thermal, highlighting a gap in our understanding of water loss from Mars. In this work, we set out to fill this knowledge gap. To accomplish our goals, we use an upgraded 1D photochemical model that fully couples ions and neutrals and does not assume photochemical equilibrium. To our knowledge, such a model has not been applied to Mars previously. We model the atmosphere during solar minimum, mean, and maximum, and find that the deuterated ionosphere behaves similarly to the H-bearing ionosphere, but that non-thermal escape on the order of 8000-9000 cm$^{-2}$s$^{-1}$ dominates atomic D loss under all solar conditions. The total fractionation factor, $f$, is $f=0.04$--0.07, and integrated water loss is 147--158 m GEL. This is still less than geomorphological estimates. Deuterated ions at Mars are likely difficult to measure with current techniques due to low densities and mass degeneracies with more abundant H ions. Future missions wishing to measure the deuterated ionosphere in situ will need to develop innovative techniques to do so.Comment: 37 pages, 8 figures, published in Journal of Geophysical Research: Planet