The Mechanics of QSR 2000

Assessment of the quality of the marine environment forms an important part of the new 1992 OSPAR Convention for the Protection of the Marine Environment of the North-East Atlantic that was ratified and entered into force on 25 March 1998. In the ministerial statement at the signing of the Convention it was agreed that the first assessment (Quality Status Report, QSR) for all Convention waters should be produced for the year 2000. To oversee this charge a new Environmental Assessment and Monitoring Committee (ASMO) was established and a junior group under this committee, to implement necessary actions, the Assessment Co-ordination Group (ACG). Because of the wide geographical diversity and varying levels of information available in different parts of the Convention area it was decided to produce five regional reports for: I The Arctic; II The North Sea; III The Celtic seas; IV The Bay of Biscay and Iberian Coast; V The Wider Atlantic, which will be synthesised in a holistic QSR for the year 2000. The report for the North Sea will largely be an update of QSR 1993 and forms the third cycle of a developing management system for the North Sea. This paper will present the procedures that have been adopted to implement the QSRs, and outlines the guidelines that have been developed for their structure, format, design and publication

Chlamydia related bacteria (Chlamydiales) in early pregnancy: community-based cohort study.

OBJECTIVES: Serological case-control studies suggest that certain chlamydia-related bacteria (Chlamydiales) which cause cows to abort may do the same in humans. Chlamydiales include Waddlia chondrophila, Chlamydia abortus and Chlamydia trachomatis. Data on prevalence of Chlamydiales in pregnancy are sparse. Using stored urine samples from a carefully characterised cohort of 847 newly pregnant women recruited from 37 general practices in London, UK, we aimed to investigate the prevalence and types of Chlamydiales infections. We also explored possible associations with miscarriage or spontaneous preterm birth. METHODS: Samples were tested using W. chondrophila and pan-Chlamydiales specific real-time PCRs targeting the 16S rRNA gene. Samples positive on either PCR were subjected to DNA sequencing and C. trachomatis PCR. RESULTS: The overall prevalence of Chlamydiales was 4.3% (36/847, 95% CI 3.0% to 5.8%). The prevalence of W. chondrophila was 0.6% (n = 5), C. trachomatis 1.7% (n = 14), and other Chlamydiales species 2.0% (n = 17). Infection with C. trachomatis was more common in women aged <25, of black ethnicity or with bacterial vaginosis, but this did not apply to W. chondrophila or other Chlamydiales. Follow up was 99.9% at 16 weeks gestation and 90% at term. No infection was significantly associated with miscarriage at ≤12 weeks (prevalence 10%, 81/827) or preterm birth <37 weeks (prevalence 4%, 23/628). Of 25 samples sequenced, seven (28%) were positive for Chlamydiales bacterium sequences associated with respiratory tract infections in children. CONCLUSION: In the first study to use the pan-Chlamydiales assay on female urine samples, 4% of pregnant women tested positive for Chlamydiales, including species known to be pathogenic in mothers and neonates

Marching sound machines: an autoethnography of a director of bands at an Historically Black College and University

The purpose of this dissertation was to elucidate my lived experiences as an HBCU band director as I navigated through tensions within HBCU culture, between HBCU culture and the dominant culture, and issues of inequality, and access. I chronicle my early life and influences to bring clarity and meaning to the choices and decisions made as I transitioned to becoming an HBCU student and then band director at an early age. It was my intention to use autoethnographic self-examination and personal narrative to make transparent racial inequality as it: (a) impacts the academic and musical quality of HBCU band programs, (b) raises questions regarding access to resources, and (c) elicits larger and more complex questions related to race and culture. In addition to a thorough review of my personal recollections and historical artifacts, I also sought to interview as many people as possible that had impacted me, my life, and HBCU bands in order to check my memory and perspectives. As the word got out about my project, hundreds in the HBCU community reached out wanting to participate. Of the eighty-seven persons that agreed to an interview, I was able to interview fifty-two. I analyzed my story through the framework of "Double-Consciousness Theory" as articulated by W. E. B. Du Bois, specifically through the concepts of the veil, the color line, and twoness. The guiding question for my inquiry was: Why is the musicianship of HBCU bands praised by one culture and viewed in a mostly deficit view in another, and how did an HBCU band director navigate these tensions to lead two successful programs? The findings demonstrate that there are multiple and conflicting expectations and perceptions of HBCU band programs. By considering HBCU bands through my own experience of double-consciousness it was possible to amplify the voices of marginalized groups and provide more nuanced understandings to those who have a one-dimensional view of such band programs

The effectiveness and efficiency of home-based nursing health promotion for older people: A review of the literature

Despite the large potential role that community nurses have in providing individualized health promotion to older people, there is a lack of consensus in the literature regarding this role's effectiveness and efficiency. This article presents a literature review and synthesis of 12 randomized controlled trials selected from 344 published studies on preventive home visitation programs for older people. The findings suggest that a diversity of home visiting interventions carried out by nurses can favorably affect health and functional status, mortality rates, use of hospitalization and nursing homes, and costs. Further research is needed that focuses on the outcomes of quality of life, mental health, social support, caregiver burden, the acceptability of intervention, and specific subgroups of clients who benefit most. Findings also indicate the need for a theoretical foundation, increased emphasis on health-promotion strategies, and more research using a more complete economic evaluation to establish efficiency

On the dynamic mechanical properties of open-cell metal foams - A re-assessment of the 'simple-shock theory'

Metal foams are increasingly used for energy absorption especially in lightweight structures and to resist blast and impact loads. This requires an understanding of the dynamic response of these materials for modelling purposes. As a supplement to Tan et al., 2005a and Tan et al., 2005b, hereinafter referred to as T–L for brevity, this paper provides experimental data for the dynamic mechanical properties of open-cell Duocel® foams having a three-dimensional (3D) distribution of cells. These confirm significant enhancement of the foam’s compressive strength, accompanied by changes in their deformation pattern in certain loading régimes, particularly what has come to be described as the ‘shock’ régime by Zheng et al. (2012). This paper examines experimentally, in a similar fashion as T–L, how the structural response of the individual cell walls is affected by cell-shape anisotropy at the cell (meso)-scale and how this, in turn, alters the pattern of cell crushing and the dynamic, mechanical properties. The distinctive role of cell microinertia and ‘shock’ formation are discussed in relation to the mechanical properties measured for these 3D cylindrical specimens. For consistency the same procedures described in T–L are used. The features identified are shown to be consistent with those observed in finite-element simulations of two-dimensional (2D) honeycombs as estimated by the one-dimensional (1D) steady-shock theory summarised in T–L. The different deformation patterns that develop in the various loading régimes are categorised according to the compression rate/impact speed. Critical values of impact velocity, corresponding to the transition from one pattern to the other, are quantified and predictive formulae for the compressive uniaxial strengths in the directions of two of the principal axes of the material in each loading régime are derived and discussed. The accuracy of the predictive formula in T–L is shown to critically depend on the ‘densification strain’ of the foam specimens. This parameter and the discussion that follows could assist the formulation and validation of alternative theoretical/computational models on the dynamic deformation of such materials

Processes at the margins of supraglacial debris cover:Quantifying dirty ice ablation and debris redistribution

Current glacier ablation models have difficulty simulating the high‐melt transition zone between clean and debris‐covered ice. In this zone, thin debris cover is thought to increase ablation compared to clean ice, but often this cover is patchy rather than continuous. There is a need to understand ablation and debris dynamics in this transition zone to improve the accuracy of ablation models and the predictions of future debris cover extent. To quantify the ablation of partially debris‐covered ice (or ‘dirty ice’), a high‐resolution, spatially‐continuous ablation map was created from repeat unmanned aerial systems (UAS) surveys, corrected for glacier flow in a novel way using on‐glacier ablation stakes. Surprisingly, ablation is similar (range ~5 mm w.e. per day) across a wide range of percentage debris covers (~30‐80%) due to the opposing effects of a positive correlation between percentage debris cover and clast size, countered by a negative correlation with albedo. Once debris cover becomes continuous, ablation is significantly reduced (by 61.6% compared to a partial debris cover), and there is some evidence that the cleanest ice (<~15% debris cover) has a lower ablation than dirty ice (by 3.7%). High‐resolution feature tracking of clast movement revealed a strong modal clast velocity where debris was continuous, indicating that debris moves by creep down moraine slopes, in turn promoting debris cover growth at the slope toe. However, not all slope margins gain debris due to the removal of clasts by supraglacial streams. Clast velocities in the dirty ice area were twice as fast than clasts within the continuously debris‐covered area, as clasts moved by sliding off their boulder tables. These new quantitative insights into the interplay between debris cover characteristics and ablation can be used to improve the treatment of dirty ice in ablation models, in turn improving estimates of glacial meltwater production

Axonal transport deficit in a KIF5A–/– mouse model

Hereditary spastic paraplegia (HSP) is a neurodegenerative disorder preferentially affecting the longest corticospinal axons. More than 40 HSP genetic loci have been identified, among them SPG10, an autosomal dominant HSP caused by point mutations in the neuronal kinesin heavy chain protein KIF5A. Constitutive KIF5A knockout (KIF5A–/–) mice die early after birth. In these mice, lungs were unexpanded, and cell bodies of lower motor neurons in the spinal cord swollen, but the pathomechanism remained unclear. To gain insights into the pathophysiology, we characterized survival, outgrowth, and function in primary motor and sensory neuron cultures from KIF5A–/– mice. Absence of KIF5A reduced survival in motor neurons, but not in sensory neurons. Outgrowth of axons and dendrites was remarkably diminished in KIF5A–/– motor neurons. The number of axonal branches was reduced, whereas the number of dendrites was not altered. In KIF5A–/– sensory neurons, neurite outgrowth was decreased but the number of neurites remained unchanged. In motor neurons maximum and average velocity of mitochondrial transport was reduced both in anterograde and retrograde direction. Our results point out a role of KIF5A in process outgrowth and axonal transport of mitochondria, affecting motor neurons more severely than sensory neurons. This gives pathophysiological insights into KIF5A associated HSP, and matches the clinical findings of predominant degeneration of the longest axons of the corticospinal tract

Association of sperm-associated antigen 5 and treatment response in patients With estrogen receptor–positive breast cancer

Importance: There is no proven test that can guide the optimal treatment, either endocrine therapy or chemotherapy, for estrogen receptor–positive breast cancer. Objective: To investigate the associations of sperm-associated antigen 5 (SPAG5) transcript and SPAG5 protein expressions with treatment response in systemic therapy for estrogen receptor–positive breast cancer. Design, Settings, and Participants: This retrospective cohort study included patients with estrogen receptor–positive breast cancer who received 5 years of adjuvant endocrine therapy with or without neoadjuvant anthracycline-based combination chemotherapy (NACT) derived from 11 cohorts from December 1, 1986, to November 28, 2019. The associations of SPAG5 transcript and SPAG5 protein expression with pathological complete response to NACT were evaluated, as was the association of SPAG5 mRNA expression with response to neoadjuvant endocrine therapy. The associations of distal relapse–free survival with SPAG5 transcript or SPAG5 protein expressions were analyzed. Data were analyzed from September 9, 2015, to November 28, 2019. Main Outcomes and Measures: The primary outcomes were breast cancer–specific survival, distal relapse–free survival, pathological complete response, and clinical response. Outcomes were examined using Kaplan-Meier, multivariable logistic, and Cox regression models. Results: This study included 12 720 women aged 24 to 78 years (mean [SD] age, 58.46 [12.45] years) with estrogen receptor–positive breast cancer, including 1073 women with SPAG5 transcript expression and 361 women with SPAG5 protein expression of locally advanced disease stage IIA through IIIC. Women with SPAG5 transcript and SPAG5 protein expressions achieved higher pathological complete response compared with those without SPAG5 transcript or SPAG5 protein expressions (transcript: odds ratio, 2.45 [95% CI, 1.71-3.51]; P < .001; protein: odds ratio, 7.32 [95% CI, 3.33-16.22]; P < .001). Adding adjuvant anthracycline chemotherapy to adjuvant endocrine therapy for SPAG5 mRNA expression in estrogen receptor–positive breast cancer was associated with prolonged 5-year distal relapse–free survival in patients without lymph node involvement (hazard ratio, 0.34 [95% CI, 0.14-0.87]; P = .03) and patients with lymph node involvement (hazard ratio, 0.35 [95% CI, 0.18-0.68]; P = .002) compared with receiving 5-year endocrine therapy alone. Mean (SD) SPAG5 transcript was found to be downregulated after 2 weeks of neoadjuvant endocrine therapy compared with pretreatment levels in 68 of 92 patients (74%) (0.23 [0.18] vs 0.34 [0.24]; P < .001). Conclusions and Relevance: These findings suggest that SPAG5 transcript and SPAG5 protein expressions could be used to guide the optimal therapies for estrogen receptor–positive breast cancer. Retrospective and prospective clinical trials are warranted

Protocol for a pilot randomised controlled clinical trial to compare the effectiveness of a graduated three layer straight tubular bandaging system when compared to a standard short stretch compression bandaging system in the management of people with venous ulceration: 3VSS2008

<p>Abstract</p> <p>Background</p> <p>The incidence of venous ulceration is rising with the increasing age of the general population. Venous ulceration represents the most prevalent form of difficult to heal wounds and these problematic wounds require a significant amount of health care resources for treatment. Based on current knowledge multi-layer high compression system is described as the gold standard for treating venous ulcers. However, to date, despite our advances in venous ulcer therapy, no convincing low cost compression therapy studies have been conducted and there are no clear differences in the effectiveness of different types of high compression.</p> <p>Methods/Design</p> <p>The trial is designed as a pilot multicentre open label parallel group randomised trial. Male and female participants aged greater than 18 years with a venous ulcer confirmed by clinical assessment will be randomised to either the intervention compression bandage which consists of graduated lengths of 3 layers of elastic tubular compression bandage or to the short stretch inelastic compression bandage (control). The primary objective is to assess the percentage wound reduction from baseline compared to week 12 following randomisation. Randomisation will be allocated via a web based central independent randomisation service (nQuery v7) and stratified by study centre and wound size ≤ 10 cm²or >10 cm². Neither participants nor study staff will be blinded to treatment. Outcome assessments will be undertaken by an assessor who is blinded to the randomisation process.</p> <p>Discussion</p> <p>The aim of this study is to evaluate the efficacy and safety of two compression bandages; graduated three layer straight tubular bandaging (3L) when compared to standard short stretch (SS) compression bandaging in healing venous ulcers in patients with chronic venous ulceration. The trial investigates the differences in clinical outcomes of two currently accepted ways of treating people with venous ulcers. This study will help answer the question whether the 3L compression system or the SS compression system is associated with better outcomes.</p> <p>Trial Registration</p> <p>ACTRN12608000599370</p

A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

BACKGROUND: Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. METHODS: Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse. RESULTS: Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%). CONCLUSIONS: A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up