Is the spiral morphology of the Elias 2-27 circumstellar disc due to gravitational instability?

A recent ALMA observation of the Elias 2-27 system revealed a two-armed structure extending out to ~300 au in radius. The protostellar disc surrounding the central star is unusually massive, raising the possibility that the system is gravitationally unstable. Recent work has shown that the observed morphology of the system can be explained by disc self-gravity, so we examine the physical properties of the disc necessary to detect self-gravitating spiral waves. Using three-dimensional Smoothed Particle Hydrodynamics, coupled with radiative transfer and synthetic ALMA imaging, we find that observable spiral structure can only be explained by self-gravity if the disc has a low opacity (and therefore efficient cooling), and is minimally supported by external irradiation. This corresponds to a very narrow region of parameter space, suggesting that, although it is possible for the spiral structure to be due to disc self-gravity, other explanations, such as an external perturbation, may be preferred.Comment: 12 pages, 5 figure

Reperfusion in the brain: is time important? The DAWN and DEFUSE-3 trials.

(Opening paragraph) Reperfusion therapy using intravenous thrombolysis and mechanical thrombectomy are the only approved treatments for acute ischaemic stroke, but must be administered in a narrow therapeutic window of up to 4.5 and 6 h, respectively. A further meta-analysis by the HERMES (Highly Effective Reperfusion evaluated in Multiple Endovascular Stroke Trials) collaboration has suggested that mechanical thrombectomy may be beneficial up to 7.3 h after stroke onset. However, the results of the DAWN (DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo) and the DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischaemic Stroke)7 trials may extend this window up to 24 h in carefully selected patients

A qualitative study exploring patients', with mild to moderate stroke, and their carers' perceptions of healthy lifestyles

Background/Aims: To explore patients', with mild to moderate stroke, and their carers' experiences after a stroke and to explore their perceptions of healthy lifestyles. Methods: A qualitative study using semi-structured interviews was undertaken with 20 people (12 males and 8 females) with mild to moderate stroke or transient ischaemic attack (1 week to 6 months' post event) and seven of their carers. Each interview was transcribed and a thematic analysis approach guided the analytic process. Results: Patients with sub-acute, mild to moderate stroke were positive about healthy lifestyles and their ability to achieve them post stroke. Three core themes were identified: perceptions related to exercise; perceptions related to other lifestyle factors; and understanding of stroke and healthy lifestyles. Conclusions: In the sub-acute phase of stroke recovery, barriers to exercise such as lack of motivation do not appear to be an issue. People with stroke have a lack of understanding of healthy guidelines, risk factors and cause of their stroke. It is not clear if this is due to a lack of information provision or a lack of recall. They also do not appear to make the link between lifestyle choices and the cause of their stroke

Is the spiral morphology of the Elias 2-27 circumstellar disc due to gravitational instability?

A recent Atacama Large Millimeter/submillimeter Array (ALMA) observation of the Elias 2-27 system revealed a two-armed structure extending out to ∼300 au in radius. The protostellar disc surrounding the central star is unusually massive, raising the possibility that the system is gravitationally unstable. Recent work has shown that the observed morphology of the system can be explained by disc self-gravity, so we examine the physical properties of the disc necessary to detect self-gravitating spiral waves. Using three-dimensional smoothed particle hydrodynamics, coupled with radiative transfer and synthetic ALMA imaging, we find that observable spiral structure can only be explained by self-gravity if the disc has a low opacity (and therefore efficient cooling), and is minimally supported by external irradiation. This corresponds to a very narrow region of parameter space, suggesting that, although it is possible for the spiral structure to be due to disc self-gravity, other explanations, such as an external perturbation, may be preferred

Qualitative Analysis of the Cognition and Flow (CoGFlowS) Study: An Individualized Approach to Cognitive Training for Dementia Is Needed.

BackgroundCognitive training (CT) may have benefits for both healthy older adults (HC) and those with early cognitive disorders [mild cognitive impairment (MCI) and dementia]. However, few studies have qualitatively evaluated home-based, computerized CT programs.ObjectiveWe present the qualitative arm of a feasibility randomized controlled trial evaluating a CT program for HC and people living with MCI or dementia.MethodsParticipants underwent semi-structured interviews after 12 weeks of CT. Where possible, participants were interviewed with their carers. The interview schedule and analysis were underpinned by the health belief model. Interviews were audio-recorded, transcribed, open-coded, and categorized into themes. The analytical framework was developed, and themes were condensed under five major categories: benefits, barriers, threat, self-efficacy, and cues to action.Results37 participants underwent interviews. CT was feasible and acceptable to participants. Benefits included: enjoyment, improved awareness, benchmarking cognitive function, reassurance of abilities and giving back control. Barriers were more prevalent among those with dementia: problems with technology, frustration, conflict between patients and carers, apathy and lack of insight, anxiety or low mood, and lack of portability. HC and MCI perceived the severity of dementia risk as high, partially mitigated by CT. Participants living with dementia valued a more individualized approach to training, accounting for baseline characteristics.ConclusionCT was a feasible intervention for HC and people living with dementia and MCI. Benefits were present, but the identified barriers need to be addressed for CT to be implemented successfully

A qualitative study exploring how stroke survivors' expectations and understanding of stroke Early Supported Discharge shaped their experience and engagement with the service

Purpose: To explore how stroke survivors’ expectations and understanding of Early Supported Discharge (ESD) helped them make sense of their experiences, and shaped their engagement with the service. Methods: Data were collected as part of a study of large-scale implementation of stroke ESD: the WISE realist mixed-methods study. Semi-structured interviews were conducted with five purposefully selected stroke survivors from six sites in England implementing stroke ESD (n = 30). Participants were aged 32–88 years (20 males). Interviews were audio recorded, transcribed verbatim and transcripts were analysed using reflexive thematic analysis. Results: Three overarching themes were identified: (1) ESD as a post-stroke recovery tool, (2) desire to recover quickly, (3) psychosocial impact and support. Stroke survivors were uncertain about what to expect when they first entered the service, however, their experience of ESD exceeded their expectations and increased their engagement with the service. Stroke survivors especially valued the goal-oriented approach the team adopted. Rehabilitation at home was perceived as positive and practical, encouraging independence within real-life contexts. Psycho-social support played an important role in the stroke survivors’ rehabilitation. Conclusions: Ensuring stroke survivors are fully informed about ESD and what to expect, optimises engagement with the services, improves experience and could enhance outcomes.IMPLICATIONS FOR REHABILITATION Informing stroke survivors about what to expect from ESD services could optimise engagement and improve their experience. The provision of personalised and target focussed therapy at home improves stroke survivors’ experience and could potentially accelerate recovery. Preparing stroke survivors early for discharge from ESD can reduce anxiety and enhance engagement with the service

Do maternal haemodynamics have a causal influence on treatment for gestational diabetes?

Arterial stiffening is believed to contribute to the worsening of insulin resistance, and factors which are associated with needing pharmacological treatment of gestational diabetes (GDM), such as maternal obesity or advanced age, are associated with impaired cardiovascular adaptation to pregnancy. In this observational study, we aimed to investigate causal relationships between maternal haemodynamics and treatment requirement amongst women with GDM. We assessed maternal haemodynamics in women with GDM, comparing those who remained on dietary treatment with those who required pharmacological management. Maternal haemodynamics were assessed using the Arteriograph® (TensioMed Ltd, Budapest, Hungary) and the NICOM® non-invasive bio-reactance method (Cheetah Medical, Portland, Oregon, USA). A graphical causal inference technique was used for statistical analysis. 120 women with GDM were included in the analysis. Maternal booking BMI was identified as having a causative influence on treatment requirement, with each unit increase in BMI increasing the odds of needing metformin and/or insulin therapy by 12% [OR 1.12 (1.02 − 1.22)]. The raw values of maternal heart rate (87.6 ± 11.7 vs. 92.9 ± 11.90 bpm, p = 0.014) and PWV (7.8 ± 1.04 vs. 8.4 ± 1.61 m/s, p = 0.029) were both significantly higher amongst the women requiring pharmacological management, though these relationships did not remain significant in causal logistic regression. Maternal BMI at booking has a causal, rather than simply associational, relationship on the need for pharmacological treatment of GDM. No significant causal relationships were found between maternal haemodynamics and the need for pharmacological treatment. This observational study is the first to examine relationships between maternal haemodynamics and treatment requirement for gestational diabetes (GDM). This is also the first study to demonstrate a causative, rather than simply associational, relationship between maternal body mass index (BMI) and the need for pharmacological treatment of GDM, with each unit increase in BMI increasing the odds of needing metformin and/or insulin therapy by 12%. Maternal heart rate and pulse wave velocity were significantly higher among women with GDM requiring pharmacological management, but this finding did not remain significant in logistic regression analysis, and no causative relationships between maternal hemodynamics and treatment requirement were identified. Our findings highlight the importance of pre- and peri-conception weight control, but do not support a role for measurement of maternal hemodynamics in the prediction of women who are likely to require pharmacological management of GDM.</p

Oral antiplatelet therapy for acute ischaemic stroke

BackgroundIn people with acute ischaemic stroke, platelets become activated and can cause blood clots to form and block an artery in the brain, resulting in damage to part of the brain. Such damage gives rise to the symptoms of stroke. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and also reduce the risk of early recurrent ischaemic stroke, thereby reducing the risk of early death and improving long‐term outcomes in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage.ObjectivesTo assess the efficacy and safety of immediate oral antiplatelet therapy (i.e. started as soon as possible and no later than two weeks after stroke onset) in people with acute presumed ischaemic stroke.Search methodsWe searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, and two trials registers, and performed forward reference/cited reference searching in August 2020.Selection criteriaRandomised controlled trials (RCTs) comparing oral antiplatelet therapy (started within 14 days of the stroke) with control in people with definite or presumed ischaemic stroke.Data collection and analysisTwo review authors independently applied the inclusion criteria and assessed trial quality. For the included trials, they extracted and cross‐checked the data. They assessed risk of bias of each study using the Risk of Bias 1 (RoB1) tool and overall certainty of the evidence for each outcome using the GRADE approach.Main resultsWe included 11 studies involving 42,226 participants. Three new trials have been added since the last update (743 participants). As per the previous version of this review, two trials testing aspirin 160 mg to 300 mg once daily, started within 48 hours of onset, contributed 96% of the data. The risk of bias was low. The maximum follow‐up was six months. With treatment, there was a decrease in death or dependency at the end of follow‐up (odds ratio (OR) 0.95, 95% confidence interval (CI) 0.91 to 0.99; 7 RCTs, 42,034 participants; moderate‐certainty evidence). For every 1000 people treated with aspirin, 13 people would avoid death or dependency (number needed to treat for an additional beneficial outcome 79).Authors' conclusionsAntiplatelet therapy with aspirin 160 mg to 300 mg daily, given orally (or by nasogastric tube or per rectum in people who cannot swallow) and started within 48 hours of onset of presumed ischaemic stroke, significantly decreased death and dependency, and reduced the risk of early recurrent ischaemic stroke without a major risk of early haemorrhagic complications; long‐term outcomes were improved.</div

The Cognition and Flow Study (CogFlowS): A Mixed Method Evaluation of a Randomized Feasibility Trial of Cognitive Training in Dementia.

BackgroundCognitive training (CT) may be beneficial in delaying the onset or slowing dementia progression. CT has been evaluated quantitatively and qualitatively, but none have used mixed methods approaches.ObjectiveThe aim of this study was to use a mixed methods approach to identify those who may selectively benefit from CT.MethodsThis was an explanatory sequential mixed methods study involving a quantitative randomized trial of 12 weeks multi-domain CT in healthy older adults (HC, n = 20), and people living with mild cognitive impairment (MCI; n = 12) and dementia (n = 24). Quantitative outcomes included: cognition, mood, quality of life, and activities of daily living. 28 (10 HC, 6 MCI, 12 dementia) training participants completed semi-structured interviews with their carer. Quantitative and qualitative data were integrated using joint displays.ResultsThree participants dropped out from the training early-on, leaving 25 participants with follow-up data for full integration (10 HC, 6 MCI, 9 dementia). Dropouts and lower adherence to training were more common in dementia participants with greater non-modifiable barriers. High adherers were more resilient to negative emotions, and poorer or fluctuating performance. Integrated analysis found the majority of participants (n = 24) benefited across outcomes, with no clear profile of individuals who benefited more than others. Participants made a number of key recommendations to improve adherence and minimize dropout to CT.ConclusionReasons for dropout and low adherence were identified, with recommendations provided for the design of CT for dementia. An individual approach to training should be adopted and low adherence should not preclude engagement with CT

[Abstract] Factors determining treatment allocation of older women with operable breast cancer: an interim analysis of the Bridging the Age Gap in Breast Cancer Study

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