P-Multigrid expansion of hybrid multilevel solvers for discontinuous Galerkin finite element discrete ordinate (DG-FEM-SN) diffusion synthetic acceleration (DSA) of radiation transport algorithms

Effective preconditioning of neutron diffusion problems is necessary for the development of efficient DSA schemes for neutron transport problems. This paper uses P-multigrid techniques to expand two preconditioners designed to solve the MIP diffusion neutron diffusion equation with a discontinuous Galerkin (DG-FEM) framework using first-order elements. These preconditioners are based on projecting the first-order DG-FEM formulation to either a linear continuous or a constant discontinuous FEM system. The P-multigrid expansion allows the preconditioners to be applied to problems discretised with second and higher-order elements. The preconditioning algorithms are defined in the form of both a V-cycle and W-cycle and applied to solve challenging neutron diffusion problems. In addition a hybrid preconditioner using P-multigrid and AMG without a constant or continuous coarsening is used. Their performance is measured against a computationally efficient standard algebraic multigrid preconditioner. The results obtained demonstrate that all preconditioners studied in this paper provide good convergence with the continuous method generally being the most computationally efficient. In terms of memory requirements the preconditioners studied significantly outperform the AMG

Current research priorities for UK occupational physicians and occupational health researchers: a modified Delphi study

Objectives: Studies identifying national occupational health (OH) research priorities have been conducted in several countries to establish where OH research should be focused and where funding should be targeted. However, the UK findings are now over 20 years old, and OH practice is continuously evolving. The aim of this study was to identify current research priorities for UK occupational physicians (OPs) and occupational health researchers (OHRs). Methods: Current research priorities in OH were identified using a modified Delphi technique. This was conducted in two rounds to achieve consensus. Research priorities were rated, and then ranked using questionnaires developed from expert panel discussions, key research topics identified from the medical literature and participant feedback. Overall and intergroup comparisons were completed for the ranking scores. Results Consensus among OPs and OHRs was high with almost all (9/10) primary domains rated as ‘very important’ or ‘absolutely necessary’ by more than 54% of respondents. The research priority areas ranked highest were jointly economic evaluation/cost effectiveness studies and disability management followed by occupational disease/injury/illness. Occupational health policy was ranked lowest after sickness absence management and health promotion. The secondary domain analysis identified priority emphasis on mental health and psychosocial hazards within the workplace and the need to further develop evidence-based guidance for clinical OH practice. Conclusions: We identified the current research priorities for UK OPs and OHRs. The findings will inform future national OH research strategy and support research that addresses important knowledge gaps within OH and other interdisciplinary specialties

Evaluation of phenotype-driven gene prioritization methods for Mendelian diseases.

Yuan et al. recently described an independent evaluation of several phenotype-driven gene prioritization methods for Mendelian disease on two separate, clinical datasets. Although they attempted to use default settings for each tool, we describe three key differences from those we currently recommend for our Exomiser and PhenIX tools. These influence how variant frequency, quality and predicted pathogenicity are used for filtering and prioritization. We propose that these differences account for much of the discrepancy in performance between that reported by them (15-26% diagnoses ranked top by Exomiser) and previously published reports by us and others (72-77%). On a set of 161 singleton samples, we show using these settings increases performance from 34% to 72% and suggest a reassessment of Exomiser and PhenIX on their datasets using these would show a similar uplift

Arsenic and selenium

Arsenic (As) and selenium (Se) have become increasingly important in environmental geochemistry because of their significance to human health. Their concentrations vary markedly in the environment, partly in relation to geology and partly as a result of human activity. Some of the contamination evident today probably dates back to the first settled civilizations that used metals. This chapter outlines the main effects of arsenic and selenium on human and animal health, their abundance and distribution in the environment, sampling and analysis, and the main factors controlling their speciation and cycling. Such information should help to identify aquifers, water resources, and soils at risk from high concentrations of arsenic and selenium, and areas of selenium deficiency. Human activity has had, and is likely to continue to have, a major role in releasing arsenic and selenium from the geosphere and in perturbing the natural distribution of these and other elements over the Earth’s surface

Sustainable farming with native rocks: the transition without revolution.

The development process which humanity passed through favored a series of conquests, reflected in the better quality of life and longevity, however, it also provoked upsets and severe transformation in the environment and in the human food security. Such process is driving the ecosystems to be homogeneous, and, therefore,the nutrients� supply, via nourishment. To change this panorama, the present work discusses the gains of incorporating the stonemeal technique as a strategic alternative to give back the essential fertile characteristics to the soils. This technology has the function of facilitating the rejuvenation of the soils and increasing the availability of the necessary nutrients to the full development of the plants which is a basic input for the proliferation of life in all its dimensions

CYP2C19 Genotype Prevalence and Association With Recurrent Myocardial Infarction in British–South Asians Treated With Clopidogrel

BACKGROUND: Cytochrome P450 family 2 subfamily C member 19 (CYP2C19) is a hepatic enzyme involved in the metabolism of clopidogrel from a prodrug to its active metabolite. Prior studies of genetic polymorphisms in CYP2C19 and their relationship with clinical efficacy have not included South Asian populations. OBJECTIVES: The objective of this study was to assess prevalence of common CYP2C19 genotype polymorphisms in a British-South Asian population and correlate these with recurrent myocardial infarction risk in participants prescribed clopidogrel. METHODS: The Genes & Health cohort of British Bangladeshi and Pakistani ancestry participants were studied. CYP2C19 diplotypes were assessed using array data. Multivariable logistic regression was used to test for association between genetically inferred CYP2C19 metabolizer status and recurrent myocardial infarction, controlling for known cardiovascular disease risk factors, percutaneous coronary intervention, age, sex, and population stratification. RESULTS: Genes & Health cohort participants (N = 44,396) have a high prevalence (57%) of intermediate or poor CYP2C19 metabolizers, with at least 1 loss-of-function CYP2C19 allele. The prevalence of poor metabolizers carrying 2 CYP2C19 loss-of-function alleles is 13%, which is higher than that in previously studied European (2.4%) and Central/South Asian populations (8.2%). Sixty-nine percent of the cohort who were diagnosed with an acute myocardial infarction were prescribed clopidogrel. Poor metabolizers were significantly more likely to have a recurrent myocardial infarction (OR: 3.1; P = 0.019). CONCLUSIONS: A pharmacogenomic-driven approach to clopidogrel prescribing has the potential to impact significantly on clinical management and outcomes in individuals of Bangladeshi and Pakistani ancestry

Phenotype-driven approaches to enhance variant prioritization and diagnosis of rare disease.

Rare disease diagnostics and disease gene discovery have been revolutionized by whole-exome and genome sequencing but identifying the causative variant(s) from the millions in each individual remains challenging. The use of deep phenotyping of patients and reference genotype-phenotype knowledge, alongside variant data such as allele frequency, segregation, and predicted pathogenicity, has proved an effective strategy to tackle this issue. Here we review the numerous tools that have been developed to automate this approach and demonstrate the power of such an approach on several thousand diagnosed cases from the 100,000 Genomes Project. Finally, we discuss the challenges that need to be overcome if we are going to improve detection rates and help the majority of patients that still remain without a molecular diagnosis after state-of-the-art genomic interpretation

A behavioural change package to prevent hand dermatitis in nurses working in the national health service (the SCIN trial): study protocol for a cluster randomised controlled trial

BACKGROUND: Hand dermatitis can be a serious health problem in healthcare workers. While a range of skin care strategies and policy directives have been developed in recent years to minimise the risk, their effectiveness and cost-effectiveness remain unclear. Evidence now suggests that psychological theory can facilitate behaviour change with respect to improved hand care practices. Therefore, we will test the hypothesis that a behavioural change intervention to improve hand care, based on the Theory of Planned Behaviour and implementation intentions, coupled with provision of hand moisturisers, can produce a clinically useful reduction in the occurrence of hand dermatitis, when compared to standard care, among nurses working in the UK National Health Service (NHS) who are particularly at risk. Secondary aims will be to assess impacts on participants’ beliefs and behaviour regarding hand care. In addition, we will assess the cost-effectiveness of the intervention in comparison with normal care. METHODS/DESIGN: We will conduct a cluster randomised controlled trial at 35 NHS hospital trusts/health boards/universities, focussing on student nurses with a previous history of atopic disease or hand eczema and on nurses in intensive care units. Nurses at ‘intervention-light’ sites will be managed according to what would currently be regarded as best practice, with provision of an advice leaflet about optimal hand care to prevent hand dermatitis and encouragement to contact their occupational health (OH) department early if hand dermatitis occurs. Nurses at ‘intervention-plus’ sites will additionally receive a behavioural change programme (BCP) with on-going active reinforcement of its messages, and enhanced provision of moisturising cream. The impact of the interventions will be compared using information collected by questionnaires and through standardised photographs of the hands and wrists, collected at baseline and after 12 months follow-up. In addition, we will assemble relevant economic data for an analysis of costs and benefits, and collect information from various sources to evaluate processes. Statistical analysis will be by multi-level regression modelling to allow for clustering by site, and will compare the prevalence of outcome measures at follow-up after adjustment for values at baseline. The principal outcome measure will be the prevalence of visible hand dermatitis as assessed by the study dermatologists. In addition, several secondary outcome measures will be assessed. DISCUSSION: This trial will assess the clinical and cost effectiveness of an intervention to prevent hand dermatitis in nurses in the United Kigdom. TRIAL REGISTRATION: ISRCTN53303171: date of registration, 21 June 2013

A behaviour change package to prevent hand dermatitis in nurses working in health care: the SCIN cluster RCT

BACKGROUND: Although strategies have been developed to minimise the risk of occupational hand dermatitis in nurses, their clinical effectiveness and cost-effectiveness remain unclear. OBJECTIVES: The Skin Care Intervention in Nurses trial tested the hypothesis that a behaviour change package intervention, coupled with provision of hand moisturisers, could reduce the point prevalence of hand dermatitis when compared with standard care among nurses working in the NHS. The secondary aim was to assess the impact of the intervention on participants' beliefs and behaviour regarding hand care, and the cost-effectiveness of the intervention in comparison with normal care. DESIGN: Cluster randomised controlled trial. SETTING: Thirty-five NHS hospital trusts/health boards/universities. PARTICIPANTS: First-year student nurses with a history of atopic tendency, and full-time intensive care unit nurses. INTERVENTION: Sites were randomly allocated to be 'intervention plus' or 'intervention light'. Participants at 'intervention plus' sites received access to a bespoke online behaviour change package intervention, coupled with personal supplies of moisturising cream (student nurses) and optimal availability of moisturising cream (intensive care unit nurses). Nurses at 'intervention light' sites received usual care, including a dermatitis prevention leaflet. MAIN OUTCOME MEASURE: The difference between intervention plus and intervention light sites in the change of point prevalence of visible hand dermatitis was measured from images taken at baseline and at follow-up. RANDOMISATION: Fourteen sites were randomised to the intervention plus arm, and 21 sites were randomised to the intervention light arm. BLINDING: The participants, trial statistician, methodologist and the dermatologists interpreting the hand photographs were blinded to intervention assignment. NUMBERS ANALYSED: An intention-to-treat analysis was conducted on data from 845 student nurses and 1111 intensive care unit nurses. RESULTS: The intention-to-treat analysis showed no evidence that the risk of developing dermatitis was greater in the intervention light group than in the intervention plus group (student nurses: odds ratio 1.25, 95% confidence interval 0.59 to 2.69; intensive care unit nurses: odds ratio 1.41, 95% confidence interval 0.81 to 2.44). Both groups had high levels of baseline beliefs about the benefits of using hand moisturisers before, during and after work. The frequency of use of hand moisturisers before, during and after shifts was significantly higher in the intensive care unit nurses in the intervention plus arm at follow-up than in the comparator group nurses. For student nurses, the intervention plus group mean costs were £2 lower than those for the comparator and 0.00002 more quality-adjusted life-years were gained. For intensive care unit nurses, costs were £4 higher and 0.0016 fewer quality-adjusted life-years were gained. HARMS: No adverse events were reported. LIMITATIONS: Only 44.5% of participants in the intervention plus arm accessed the behaviour change package. CONCLUSION: The intervention did not result in a statistically significant decrease in the prevalence of hand dermatitis in the intervention plus group. FUTURE WORK: Participants had a high level of baseline beliefs about the importance of using hand moisturisers before, during and after work. Future research should focus on how workplace culture can be changed in order for that knowledge to be actioned. TRIAL REGISTRATION: Current Controlled Trials ISRCTN53303171. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 58. See the NIHR Journals Library website for further project information

Shell formation and star formation in superbubble DEM 192

Was star formation in the OB associations, LH 51 and LH 54, triggered by the growth of the superbubble DEM 192? To examine this possibility, we investigate the stellar contents and star formation history, and model the evolution of the shell. H-R diagrams constructed from UBV photometry and spectral classifications indicate highly coeval star formation, with the entire massive star population having an age of ~< 2-3 Myr. However, LH 54 is constrained to an age of ~3 Myr by the presence of a WR star, and the IMF for LH 51 suggests a lower-mass limit implying an age of 1-2 Myr. There is no evidence of an earlier stellar population to create the superbubble, but the modeled shell kinematics are consistent with an origin due to the strongest stellar winds of LH 54. It might therefore be possible that LH 54 created the superbubble, which in turn may have triggered the creation of LH 51. Within the errors, the spatial distribution of stellar masses and IMF appear uniform within the associations. We reinvestigate the estimates for stellar wind power L_w(t), during the H-burning phase, and note that revised mass-loss rates yield a significantly different form for L_w(t), and may affect stellar evolution timescales. We also model superbubble expansion into an ambient medium with a sudden, discontinuous drop in density, and find that this can easily reproduce the anomalously high shell expansion velocities seen in many superbubbles.Comment: 18 pages, 12 figures, AASTeX; Figure 1 bitmapped. Accepted to AJ. Table of Contents and preprint, including hi-resolution version of Figure 1, available at: http://www.ast.cam.ac.uk/~oey/oeypubs.htm