Three-Dimensional Myocardial Perfusion Maps by Contrast Echocardiography

We evaluated the clinical applicability of a system for three-dimensional (3-D) display of a perfusion map following myocardial contrast echocardiography (MCE). The system was used in 12 patients (9 males and 3 females, mean age 52 ± 10 years) undergoing interventional treatment of chronic total coronary occlusion. In each patient three standard apical views were acquired at baseline with sonicated IopamidolR injections into the left coronary artery (LCA) and into the right coronary artery (RCA). Following successful recanalization of the occluded artery MCE was repeated. The patients tolerated the procedure well. Acquisition of three standard apical views provided sufficient information for the reconstruction of 3-D perfusion maps containing the 16 standard left ventricular (LV) segments. Side-by-side display of the perfusion maps obtained following LCA and RCA echocontrast injections allowed us to classify the myocardial segments (192) into three groups: (1) those supplied by one major artery (124); (2) those supplied by collaterals from contralateral or both major arteries (58); and (3) segments supplied by none of the major arteries (10). Decreased opacification was observed in 50 segme

Photoelectron imaging of the SO3 anion: vibrational resolution in photoelectron angular distributions*

The photoelectron imaging of the pyramidal sulphite radical monoanion is presented in the photon energy range spanning 3.10–4.45 eV. Two features are seen corresponding to formation of the ground electronic state of the neutral and to thermionic emission, which is seen for hv > 3.7 eV. Photoelectron spectra corresponding to direct detachment show vibrational structure associated with the v2 umbrella mode of the neutral. A similar structure is seen in the photoelectron angular distributions. The photoelectron angular distributions were modelled and agree with experiment. However, we cannot provide an explanation for the observed vibrational structure in the photoelectron angular distributions. The observed thermionic emission is assigned to the excitation to a pair of degenerate Feshbach resonances, which can internally convert and subsequently emit electrons statistically

Patient Choice for Older People in English NHS Primary Care: Theory and Practice

In the English National Health Service (NHS), patients are now expected to choose the time and place of treatment and even choose the actual treatment. However, the theory on which patient choice is based and the implementation of patient choice are controversial. There is evidence to indicate that attitudes and abilities to make choices are relatively sophisticated and not as straightforward as policy developments suggest. In addition, and surprisingly, there is little research on whethermaking individual choices about care is regarded as a priority by the largest NHS patient group and the single largest group for most GPs—older people.This conceptual paper examines the theory of patient choice concerning accessing and engaging with healthcare provision and reviews existing evidence on older people and patient choice in primary care

Fingerprinting the Excited State Dynamics in Methyl Ester and Methyl Ether Anions of Deprotonated para-Coumaric Acid

Chromophores based on the para-hydroxycinnamate moiety are widespread in the natural world, including as the photoswitching unit in photoactive yellow protein and as a sunscreen in the leaves of plants. Here, photodetachment action spectroscopy combined with frequency- and angle-resolved photoelectron imaging is used to fingerprint the excited state dynamics over the first three bright action-absorption bands in the methyl ester anions (pCEs−) of deprotonated para-coumaric acid at a temperature of ≈300K. The excited states associated with the action- absorption bands are classified as resonances because they are situated in the detachment continuum and are open to autodetachment. The frequency-resolved photoelectron spectrum for pCEs− indicates that all photon energies over the S1(ππ∗) band lead to similar vibrational autodetachment dynamics. The S2(nπ∗) band is Herzberg-Teller active and has comparable brightness to the higher lying 21(ππ∗) band. The frequency-resolved photoelectron spectrum over the S2(nπ∗) band indicates more efficient internal conversion to the S1(ππ∗) state for photon energies resonant with the Franck-Condon modes (≈80 %) compared with the Herzberg-Teller modes (≈60%). The third action-absorption band, which corresponds to excitation of the 21(ππ∗) state, shows com- plex and photon-energy-dependent dynamics, with 20–40% of photoexcited population internally converting to the S1(ππ∗) state. There is also evidence for a mode-specific competition between prompt autodetachment and internal conversion on the red edge of the 21(ππ∗) band. There is no evidence for recovery of the ground elec- tronic state and statistical electron ejection (thermionic emission) following photoexcitation over any of the three action-absorption bands. Photoelectron spectra for the deprotonated methyl ether derivative (pCEt−) at photon energies over the S1(ππ∗) and S2(nπ∗) bands indicate diametrically opposed dynamics compared with pCEs−, namely intense thermionic emission due to efficient recovery of the ground electronic state

Ultrafast valence to non-valence excited state dynamics in a common anionic chromophore

Non-valence states in neutral molecules (Rydberg states) have well-established roles and importance in photochemistry, however, considerably less is known about the role of non-valence states in photo-induced processes in anions. Here, femtosecond time-resolved photoelectron imaging is used to show that photoexcitation of the S1(ππ*) state of the methyl ester of deprotonated para-coumaric acid – a model chromophore for photoactive yellow protein (PYP) – leads to a bifurcation of the excited state wavepacket. One part remains on the S1(ππ*) state forming a twisted intermediate, whilst a second part leads to the formation of a non-valence (dipole-bound) state. Both populations eventually decay independently by vibrational autodetachment. Valence-to-non-valence internal conversion has hitherto not been observed in the intramolecular photophysics of an isolated anion, raising questions into how common such processes might be, given that many anionic chromophores have bright valence states near the detachment threshold

Food cost and availability in a rural setting in Australia

Introduction: The burden of chronic diseases is rapidly increasing worldwide. In&nbsp; Australia rural populations have a greater burden of disease. Chronic diseases are largely preventable with diet as a key risk factor. With respect to diet-related chronic disease, dietary risk may be due to poor food access, namely, poor availability and/or the high cost of healthy food. It is likely that poor food access is an issue in rural areas. Objective: To assess food access in rural south-west (SW) Victoria, Australia.Methods: A total of 53 supermarkets and grocery stores in 42 towns participated in a survey of food cost and availability in the rural area of SW Victoria. The survey assessed availability and cost of a Healthy Food Access Basket (HFAB) which was designed to meet the nutritional needs of a family of 6 for 2 weeks.Results: Seventy-two percent of the eligible shops in SW Victoria were surveyed. The study found that the complete HFAB was significantly more likely to be available in a town with a chain-owned store (p&lt;0.00). The complete HFAB was less likely to be available from an independently owned store in a town with only one grocery shop (p&lt;0.004). The average cost of the HFAB across SW Victoria was AU380.30 ± 25.10 (mean &plusmn; SD). There was a mean range in difference of cost of the HFAB of $36.92. In particular, high variability was found in the cost of fruits and vegetables.Conclusions: Cost and availability of healthy food may be compromised in rural areas. Implications: Improvements in food access in rural areas could reduce the high burden of disease suffered by rural communities.<br /

Performance of a cognitive load inventory during simulated handoffs: Evidence for validity.

BackgroundAdvancing patient safety during handoffs remains a public health priority. The application of cognitive load theory offers promise, but is currently limited by the inability to measure cognitive load types.ObjectiveTo develop and collect validity evidence for a revised self-report inventory that measures cognitive load types during a handoff.MethodsBased on prior published work, input from experts in cognitive load theory and handoffs, and a think-aloud exercise with residents, a revised Cognitive Load Inventory for Handoffs was developed. The Cognitive Load Inventory for Handoffs has items for intrinsic, extraneous, and germane load. Students who were second- and sixth-year students recruited from a Dutch medical school participated in four simulated handoffs (two simple and two complex cases). At the end of each handoff, study participants completed the Cognitive Load Inventory for Handoffs, Paas' Cognitive Load Scale, and one global rating item for intrinsic load, extraneous load, and germane load, respectively. Factor and correlational analyses were performed to collect evidence for validity.ResultsConfirmatory factor analysis yielded a single factor that combined intrinsic and germane loads. The extraneous load items performed poorly and were removed from the model. The score from the combined intrinsic and germane load items associated, as predicted by cognitive load theory, with a commonly used measure of overall cognitive load (Pearson's r = 0.83, p &lt; 0.001), case complexity (beta = 0.74, p &lt; 0.001), level of experience (beta = -0.96, p &lt; 0.001), and handoff accuracy (r = -0.34, p &lt; 0.001).ConclusionThese results offer encouragement that intrinsic load during handoffs may be measured via a self-report measure. Additional work is required to develop an adequate measure of extraneous load

Proving Craig and Lyndon Interpolation Using Labelled Sequent Calculi

We have recently presented a general method of proving the fundamental logical properties of Craig and Lyndon Interpolation (IPs) by induction on derivations in a wide class of internal sequent calculi, including sequents, hypersequents, and nested sequents. Here we adapt the method to a more general external formalism of labelled sequents and provide sufficient criteria on the Kripke-frame characterization of a logic that guarantee the IPs. In particular, we show that classes of frames definable by quantifier-free Horn formulas correspond to logics with the IPs. These criteria capture the modal cube and the infinite family of transitive Geach logics

Medical students’ views about having different types of problem-based learning tutors

Background At Norwich Medical School, Year 3 or 4 medical students taking a year out of the 5-year undergraduate MBBS degree to do a master’s degree in clinical education worked as near-peer problem-based learning (PBL) tutors for students in Year 2. Peer-assisted learning has been shown to benefit both peer tutors and tutees; in this study, experiences of students with near-peer PBL tutors were compared to students with other types of PBL tutor. Methods Using existing student evaluation data, we compared student views about PBL tutor performance, PBL group functioning, and overall satisfaction with PBL learning experience according to whether their PBL tutor/s were (1) a single near-peer tutor (later-year MB BS student), (2) a single staff tutor, (3) multiple staff tutors, or (4) multiple newly qualified doctor tutors. Results Results indicated that students’ evaluation of tutor performance was more positive for near-peer PBL tutors compared to both groups of staff tutors for most areas evaluated. Additionally, students’ evaluation of overall satisfaction with PBL was more positive for near-peer PBL tutors compared to multiple staff tutors. Tutor performance for multiple staff tutors was evaluated less positively compared to both single staff and multiple newly qualified doctor groups. But there were no statistically significant differences between the four groups regarding PBL group functioning. Conclusion Near-peer PBL tutors perform comparably or better to staff PBL tutors in salient measures of tutor performance and group functioning. We conclude that medical students find near-peer PBL tutors to be an acceptable addition to the PBL tutor workforce