A primary care Symptoms Clinic for patients with medically unexplained symptoms : pilot randomised trial

Peer reviewedPublisher PD

The microcirculation as a functional system

This review examines experimental evidence that the microvascular dysfunction that occurs early in sepsis is the critical first stage in tissue hypoxia and organ failure. A functional microvasculature maintains tissue oxygenation despite limitations on oxygen delivery from blood to tissue imposed by diffusion; the density of perfused (functional) capillaries is high enough to ensure appropriate diffusion distances, and arterioles regulate the distribution of oxygen within the organ precisely to where it is needed. Key components of this regulatory system are the endothelium, which communicates and integrates signals along the microvascular network, and the erythrocytes, which directly monitor and regulate oxygen delivery. During hypovolemic shock, a functional microvasculature responds to diminish the impact of a decrease in oxygen supply on tissue perfusion. However, within hours of the onset of sepsis, a dysfunctional microcirculation is, due to a loss of functional capillary density and impaired regulation of oxygen delivery, unable to maintain capillary oxygen saturation levels and prevent the rapid onset of tissue hypoxia despite adequate oxygen supply to the organ. The mechanism(s) responsible for this dysfunctional microvasculature must be understood in order to develop appropriate management strategies for sepsis

iBully: the impact of gender of bully and victim on perception of cyberbullying and its consequences

In today\u27s technologically sophisticated world, people have many electronic methods of exchanging information and communicating. Unfortunately, these methods are not always used in positive ways; they can also be used to convey aggression and bullying. Recently, such acts of aggression have been labeled many things from cyberbullying to online social cruelty, and have received much media attention due to their tragic consequences including victim suicide. This study explores the impact of victim and bully gender in relation to perception of bully likability, punishment, impact on victim, and victim responses. Participants reviewed a Cyberbullying scenario in which the gender of the victim and perpetrator were manipulated. All scenarios were identical except for the gender pairs of the victim and perpetrator: Male (bully)-Male (victim), Male (bully)-Female (victim), Female (bully)-Female (victim), and Female (bully)-Male (victim). Participants then completed the Likability of Bully, Punishment for Bully, Impact on Victim, and Victim Response scales. A main effect of gender on the Punishment Scale for the gender of bully indicated that participants desired lighter punishment for females independent of the gender of the victim. The results of this study suggest that increasing awareness of the seriousness of all cyberbullying regardless of gender of bully is important

Glueball mass measurements from improved staggered fermion simulations

We present the first 2+1 flavour spectrum measurements of glueball states using high statistics simulations with improved staggered fermions. We find a spectrum consistent with quenched measurements of scalar, pseudoscalar andtensor glueball states. The measurements were made using 5000 configurations at a lattice spacing of 0.123 fm and pion mass of 280 MeV and 3000 configurations at 0.092 fm with a pion mass of 360 MeV. We see some evidence of coupling to 2 pion states. We compare our results with the experimental glueball candidate spectrum as well as quenched glueball estimates.Comment: 22 pages, 19 figures and 8 tables, minor additions on mixing post-refere

COMPETITIVE AND METABOLIC STRATEGIES OF MARINE BACTERIA AND THEIR INFLUENCE ON OCEAN ECOLOGY AND BIOGEOCHEMISTRY

Marine bacterial communities play a crucial role in biogeochemical cycling of carbon and other elements in the global ocean. Cyanobacteria photosynthesize, fixing carbon that forms the basis of the marine food web. Heterotrophic bacteria in turn metabolize fixed carbon compounds for energy and secondary production (generation of new heterotrophic bacterial biomass), remineralizing it to carbon dioxide that will eventually be released back into the atmosphere. The interplay between these autotrophic and heterotrophic processes determines whether atmospheric carbon is exported to the deep ocean. Thus, understanding this interplay with model organisms and complex natural marine bacterial communities is important for carbon cycle modeling as climate change alters marine ecosystems. This dissertation combines culturing, traditional genetics, and bioinformatics techniques to better understand the roles of bacterial species, genera, and families in carbon cycling. I used co-culture and traditional genetics to describe an interbacterial killing phenotype in the coastal generalist Ruegeria pomeroyi DSS-3, which allows other researchers using this model organism for carbon metabolism studies to design their experiments with this phenotype factored into the design. I used quantitative metagenomics to assemble two new Synechococcus genomes from the iron-limited Northeast Pacific. My analysis of these genomes revealed the apparent gene loss of a major nitrogen assimilation pathway that not only could restrict this genus’ ability to contribute to new primary production in this region, but also is likely relevant in several other iron-limited regions of the global ocean. Finally, I employed quantitative metagenomics and metatranscriptomics in a Northeastern Atlantic dissolved organic carbon incubation experiment to calculate bacterial community growth rates on DOC at the family, genus, and species level. These growth rates were used to identify key taxa n DOC remineralization, and metatranscriptome read mapping to these key players provided clues as to what compounds could have been fueling their growth. Overall, this dissertation uses a variety of genetic and genomic techniques to improve our understanding of multiple aspects of marine microbial community dynamics, from inter-species competition to autotrophic primary productivity to heterotrophic secondary productivity.Doctor of Philosoph

Reduced complexity of activity patterns in patients with Chronic Fatigue Syndrome: a case control study

ABSTRACT: BACKGROUND: Chronic fatigue syndrome (CFS) is an illness characterised by pervasive physical and mental fatigue without specific identified pathological changes. Many patients with CFS show reduced physical activity which, though quantifiable, has yielded little information to date. Nonlinear dynamic analysis of physiological data can be used to measure complexity in terms of dissimilarity within timescales and similarity across timescales. A reduction in these objective measures has been associated with disease and ageing. We aimed to test the hypothesis that activity patterns of patients with CFS would show reduced complexity compared to healthy controls. METHODS: We analysed continuous activity data over 12 days from 42 patients with CFS and 21 matched healthy controls. We estimated complexity in two ways, measuring dissimilarity within timescales by calculating entropy after a symbolic dynamic transformation of the data and similarity across timescales by calculating the fractal dimension using allometric aggregation. RESULTS: CFS cases showed reduced complexity compared to controls, as evidenced by reduced dissimilarity within timescales (mean (SD) Renyi(3) entropy 4.05 (0.21) vs. 4.30 (0.09), t = -6.6, p < 0.001) and reduced similarity across timescales (fractal dimension 1.19 (0.04) vs. 1.14 (0.04), t = 4.2, p < 0.001). This reduction in complexity persisted after adjustment for total activity. CONCLUSION: Patients with CFS show evidence of reduced complexity of activity patterns. Measures of complexity applied to activity have potential value as objective indicators for CFS

Impact of Incremental Perfusion Loss on Oxygen Transport in a Capillary Network Mathematical Model.

OBJECTIVES: To quantify how incremental capillary perfusion loss, such as that seen in experimental models of sepsis, affects tissue oxygenation using a computation model of oxygen transport. METHODS: A computational model was applied to capillary networks with dimensions 84x168x342 (NI) and 70x157x268 (NII) μm, reconstructed in vivo from rat skeletal muscle. Functional capillary density (FCD) loss was applied incrementally up to ~40% and combined with high tissue oxygen consumption to simulate severe sepsis. RESULTS: A loss of ~40% FCD loss decreased median tissue PO2 to 22.9 and 20.1 mmHg in NI and NII compared to 28.1 and 27.5 mmHg under resting conditions. Increasing red blood cell supply rate (SR) to baseline levels returned tissue PO2 to within 5% of baseline. High consumption combined with a 40% FCD loss, resulted in tissue anoxia in both network volumes and median tissue PO2 of 11.5 and 8.9 mmHg in NI and NII respectively; median tissue PO2 was recovered to baseline levels by increasing total SR 3 - 4 fold. CONCLUSIONS: These results suggest a substantial increase in total SR is required in order to compensate for impaired oxygen delivery as a result of loss of capillary perfusion and increased oxygen consumption during sepsis. This article is protected by copyright. All rights reserved

Fuel poverty increases risk of mould contamination, regardless of adult risk perception & ventilation in social housing properties

INTRODUCTION: Fuel poverty affects 2.4 million UK homes leading to poor hygrothermal conditions and risk of mould and house dust mite contaminations, which in turn increases risk of asthma exacerbation. For the first time we assess how fuel poverty, occupants' risk perception and use of mechanical ventilation mediate the risk of mould contamination in social housing. METHODS: Postal questionnaires were sent to 3867 social housing properties to collect adult risk perception, and demographic and environmental information on occupants. Participant details were linked to data pertaining to the individual properties. Multiple logistic regression was used to calculate odds ratios and confidence intervals while allowing for clustering of individuals coming from the same housing estate. We used Structured Equation Modelling and Goodness of Fit analysis in mediation analyses to examine the role of fuel poverty, risk perception, use of ventilation and energy efficiency. RESULTS: Eighteen percent of our target social housing populations (671 households) were included into our study. High risk perception (score of 8-10) was associated with reduced risk of mould contamination in the bedrooms of children (OR 0.5 95% CI; 0.3-0.9) and adults (OR 0.4 95% CI; 0.3-0.7). High risk perception of living with inadequate heating and ventilation reduced the risk of mould contamination (OR 0.5 95% CI; 0.3-0.8 and OR 0.5 95% CI; 0.3-0.7, respectively). Participants living with inadequate heating and not heating due to the cost of fuel had an increased risk of mould contamination (OR 3.4 95% CI; 2.0-5.8 and OR 2.2 95% CI; 1.5-3.2, respectively). Increased risk perception and use of extractor fans did not mediate the association between fuel poverty behaviours and increased risk of mould contamination. DISCUSSION: Fuel poverty behaviours increased the risk of mould contamination, which corresponds with existing literature. For the first time we used mediation analysis to assess how this association maybe modified by occupant behaviours. Increased risk perception and use of extractor fans did not modify the association between fuel poverty and mould contamination. This suggests that fuel poor populations may not benefit from energy efficiency interventions due to ineffective heating and ventilation practices of those occupants residing participating households. Our findings may be modified by a complex interaction between occupant behaviours and the built environment. We found that participant age, occupancy, SES, pets, drying washing indoors, geographic location, architectural design/age of the property, levels of insulation and type of heating regulated risk of mould contamination. CONCLUSION: Fuel poverty behaviours affected around a third of participating households and represent a risk factor for increased exposures to damp and mouldy conditions, regardless of adult risk perception, heating and ventilation practices. This requires multidisciplinary approach to assess the complex interaction between occupant behaviours, risk perception, the built environment and the effective use of heating and ventilation practices. STUDY IMPLICATIONS: Our findings have implications for housing policies and future housing interventions. Effective communication strategies focusing on awareness and perception of risk may help address indoor air quality issues. This must be supported by improved household energy efficiency with the provision of more effective heating and ventilation strategies, specifically to help alleviate those suffering from fuel poverty.European Regional Development Fund Programme  202497 50002

The use of trained volunteers in the response to out-of-hospital cardiac arrest – the GoodSAM Experience

In England, fewer than 1 in 10 out-of-hospital cardiac arrest victims survive to hospital discharge. This could be substantially improved by increasing bystander cardiopulmonary resuscitation and Automated External Defibrillator use. GoodSAM is a mobile-phone, app-based system, alerting trained individuals to nearby cardiac arrests. ‘Responders’ can be notified by bystanders using the GoodSAM ‘Alerter’ function. In London, when a 999 call-handler identifies cardiac arrest, in addition to dispatching the usual professional resources, London Ambulance Service automatically activates nearby GoodSAM responders. This article discusses the development of GoodSAM, its integration with London Ambulance Service, and the plans for future expansion