Another Target for NO

Nitric oxide (NO) is a poisonous free radical made by phagocytic cells to combat pathogens. Richardson et al. (2011) show that the Salmonella enterica serovar Typhimurium lipoamide dehydrogenase is a target for the nitrosative stress exerted by NO and related reactive nitrogen species

Research in progress--LungSEARCH: a randomised controlled trial of surveillance for the early detection of lung cancer in a high-risk group.

UNLABELLED: Low-dose CT screening for lung cancer is effective but expensive. Therefore, cheaper or more focused screening strategies may be required. LungSEARCH is a randomised prospective trial of 1568 high-risk individuals (ie, current or former moderate to heavy smokers with mild/moderate COPD) who undergo either annual sputum cytology/cytometry testing or no screening. Those with abnormal sputum then receive annual CT and fluorescent bronchoscopy for the remainder of 5 years, to identify early stage lung cancer. It is hoped that these simple initial tests could identify those requiring expensive CT scans, and the aim is to demonstrate a stage shift towards early stage cancers.Trial registration numbers ISRCTN: ISRCTN80745975, clinicaltrials.gov: NCT00512746

The Cost of Visit-based Home Care for up to Two Weeks in the Last Three Months of Life:A Pilot Study of Community Care Based at a Hospice-athome Service in South East of England

Purpose: The cost of visit-based community care based around a 24/7 hospice-at-home (HatH) service in the last 3 months of life was assessed. Methods: Thirty families completed a health and social care diary of at-home visits over two-weeks following contact with the HatH night service. Findings: Diaries captured 333 days of care provision, averaging 11 diary days per family, 708 health care professional and carer visits, lasting 604 hours at a cost of £20,192 ($24,946). Conclusions: HatH care, integrated with community support, seems an economic proposition but highlights the complexities of assessing cost of end of life care

The cost of a night nursing service at Rennie Grove Hospice Care (RGHC), and the total community cost of care at home compared to an admission to hospital

Background. RGHC runs a Hospice at Home service providing 24/7 care. An independent study calculated the cost of a RGHC visit and the total community cost of home care, including all health care professional (HCP), carer, and family member visits. Methods. Over a period of 145 days, 550 calls and 335 visits made to/by the night team were recorded, averaging 3.79 per night. The salary cost per hour for each nurse, plus organizational add on costs, was calculated. To derive a total community cost, 35 families, considered by the nursing team to be able to consent, kept a diary for up to two-weeks, recording all HCP, carer and family support visits and duration of each visit. 17 diaries were returned. Descriptive analysis was used with the Statistical Package for the Social Sciences (SPSS v22). Costs were taken for HCPs and social care services from the PSSRU data 2015/16. Results. The average length of the diaries was 10.4 days. For 3.79 visits per night the cost per visit was £195 (taking into consideration that RGHC nurses travel in pairs). The 17 patient diaries covered a total of 177 days and showed a range of visits and complexity of care. RGHC staff provided 19% of the care at a cost of £3295; district nurses 13%, cost £2005; and formal carers 55% at a cost of £1344. 23 GPs visits comprised 4% of all visits but 15% of total costs. MacMillan/Marie Curie nurses accounted for just 2% of visits but 19% of cost as they stayed overnight. The entire cost of 177 days of care for 17 patients at end of life was £11,814; ie £66.7 per day as care was not needed every day of each diary period. Conclusions. The cost of home care seems acceptable, compared to the national average cost of a day in an inpatient specialist palliative care bed at £397-£400 (Data.Gov.UK 2015)

Status of the Solar Neutrino Puzzle

Using the latest results from the solar neutrino experiments and a few standard assumptions, I show that the popular solar models are ruled out at the 3$\sigma$ level or at least TWO of the experiments are incorrect. Alternatively, one of the assumptions could be in error. These assumptions are spelled out in detail as well as how each one affects the argument.Comment: Latex, 8 pages + 4 uuencoded figures, minor changes made, FERMILAB-PUB/273-

How satisfied are carers/families with a night team service, as part of 24/7 hospice at home care?

Background. Rennie Grove Hospice Care (RGHC) runs a 24/7 service with an on call night team. Through an independent study, carer’s levels of service satisfaction with the night team were investigated. Methods. A questionnaire was sent to carers (n=268) who had a relative die under the care of RGHC within the last 6 weeks to one year, 84 completed questionnaires were returned. Follow-up face-to-face semi-structured interviews were carried out with carers (n=18). Quantitative data was analysed using SPSS v 22, while qualitative data was thematically analysed. Results. The carer questionnaire reported that 71% thought the speed of the response by the night team was fast. Overall satisfaction with telephone call response was high with 82% very satisfied. Cares also agreed strongly that the telephone calls provided good quality of care (90%), good follow-up care (88%), that they were given sufficient time (88%), and received useful advice (83%). For a visit, 93% of carers were highly satisfied and 7% satisfied. Carers strongly agreed that they were given sufficient time (90%), and were confident in the care provided (90%), care was useful (87%) and follow-up was good (84%), worries were reduced (81%) and they had a say in decisions made (81%). During the interviews, carers described the night service as: supportive, amazing, caring, reassuring, professional, kind and compassionate, excellent, loving, calm. Carers perceived the service to be holistic and rated the service highly for supporting them to ensure family members could be cared for at home, as preferred. For comparison, of those dying in hospital, only 46% were highly satisfied. Carer wellbeing scores were lower than the national average, but reported similar levels of anxiety. Conclusions. A night team service can provide excellent, reassuring and holistic care that meets the care needs and wishes of the patient and family

Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an open-label, pragmatic, randomised controlled trial

SummaryBackgroundThe diagnosis and staging of lung cancer is an important process that identifies treatment options and guides disease prognosis. We aimed to assess endobronchial ultrasound-guided transbronchial needle aspiration as an initial investigation technique for patients with suspected lung cancer.MethodsIn this open-label, multicentre, pragmatic, randomised controlled trial, we recruited patients who had undergone a CT scan and had suspected stage I to IIIA lung cancer, from six UK centres and randomly assigned them to either endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) or conventional diagnosis and staging (CDS), for further investigation and staging. If a target node could not be accessed by EBUS-TBNA, then endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was allowed as an alternative procedure. Randomisation was stratified according to the presence of mediastinal lymph nodes measuring 1 cm or more in the short axis and by recruiting centre. We used a telephone randomisation method with permuted blocks of four generated by a computer. Because of the nature of the intervention, masking of participants and consenting investigators was not possible. The primary endpoint was the time-to-treatment decision after completion of the diagnostic and staging investigations and analysis was by intention-to-diagnose. This trial is registered with ClinicalTrials.gov, number NCT00652769.FindingsBetween June 10, 2008, and July 4, 2011, we randomly allocated 133 patients to treatment: 66 to EBUS-TBNA and 67 to CDS (one later withdrew consent). Two patients from the EBUS-TBNA group underwent EUS-FNA. The median time to treatment decision was shorter with EBUS-TBNA (14 days; 95% CI 14–15) than with CDS (29 days; 23–35) resulting in a hazard ratio of 1·98, (1·39–2·82, p<0·0001). One patient in each group had a pneumothorax from a CT-guided biopsy sample; the patient from the CDS group needed intercostal drainage and was admitted to hospital.InterpretationTransbronchial needle aspiration guided by endobronchial ultrasound should be considered as the initial investigation for patients with suspected lung cancer, because it reduces the time to treatment decision compared with conventional diagnosis and staging techniques.FundingUK Medical Research Council

Chikungunya Disease Awareness Among U.S. Travelers to Caribbean Destinations

Introduction: This study investigated chikungunya disease awareness and its predictors, the level of adoption of recommended personal protective behaviors against chikungunya, and the health information-seeking behavior of U.S. travelers to Caribbean destinations.Methods: A cross-sectional retrospective online survey of 653 adult U.S. international travelers who visited any one of 34 Caribbean destinations was conducted in October 2015. Study participants were recruited through Amazon® Mechanical Turk. Travelers who met the inclusion criteria and gave informed consent were subsequently redirected to complete the survey which was domiciled in Qualtrics®.Results: Results regarding health information-seeking behavior indicated that 51% of study participants had never sought information about chikungunya or any vector-borne illnesses. Only thirty percent of study participants reported having heard of chikungunya disease before participating in this study. After adjusting for the presence of other variables in a logistic regression model, gender of female, higher levels of education, more time spent at the destination, and a higher number of hours spent engaging in outdoor activities were factors significantly associated with chikungunya disease awareness. Study results also showed that twenty-two percent of study participants did not engage in any of the three recommended personal protective behaviors under investigation.Conclusion: Study findings highlighted a gap in existing approaches to health information dissemination vis-à-vis adoption of recommended personal protective behaviors, especially for U.S. travelers at risk for chikungunya and other emerging mosquito-borne infectious diseases in Caribbean destinations

The biochemical characterization of a novel non-haem-iron hydroxylamine oxidase from Paracoccus denitrificans GB17

The characterization of the hydroxylamine oxidase from the heterotrophic nitrifier Paracoccus denitrificans GB17 indicates the enzyme to be entirely distinct from the hydroxylamine oxidase from the autotrophic nitrifier Nitrosomonas europaea. Hydroxylamine oxidase from P. denitrificans contains three to five non-haem, non-iron-sulphur iron atoms as prosthetic groups, predominantly co-ordinated by carboxylate ligands. The interaction of the enzyme with the electron-accepting proteins cytochrome C556 and pseudoazurin is mainly hydrophobic. The catalytic mechanism of hydroxylamine oxidase from P. denitrificans is different from the enzyme from N. europaea because the production of nitrite by the former requires molecular oxygen. Under anaerobic conditions the enzyme makes nitrous oxide as a sole product

Interpreting the Media Logic behind Editorial Decisions

This article enters into debates about media logic in political coverage by way of a case study of the 2015 U.K. General Election. We quantitatively and qualitatively examine two dominant themes of coverage—news about campaign rallies and horse-race reporting—as both are widely seen in political communication scholarship as symptomatic of a media logic. We draw on a content analysis of BBC, ITV, Sky News, Channel 4, and Channel 5 U.K. national television newscasts and semi-structured interviews with their heads of news and/or senior editors to help interpret how far a media logic was the editorial driving force behind coverage. At face value, our content analysis appears to support the media logic thesis, with all broadcasters—in particular commercial television newscasts—covering more process than policy issues. But our case study questions the antecedents of media logic and shines a light on a political logic that may have remained in the dark in large-scale content analysis studies. In following a political logic, we argue that this promoted the horse-race narrative, and naturalized the parties’ highly stage-managed rallies and walkabout