Comparative Effectiveness of Step-up Therapies in Children with Asthma Prescribed Inhaled Corticosteroids : A Historical Cohort Study

This work was supported by the Respiratory Effectiveness Group. Acknowledgments We thank the Respiratory Effectiveness Group for funding this work, Annie Burden for assistance with statistics, and Simon Van Rysewyk and Lisa Law for assistance with medical writing.Peer reviewedPostprin

Applying UK real world primary care data to predict asthma attacks in 3776 well-characterised children : a retrospective cohort study

FUNDING This analysis was funded by Respiratory Effectiveness Group DATA AVAILABILITY STATEMENT Data are available from Clinical Practice Research Datalink (https://www.cprd.com/home/) and Optimum Patient Care (http://optimumpatientcare.org/about-us/).Peer reviewedPublisher PD

Complex X-ray Absorption and the Fe Kalpha Profile in NGC 3516

We present data from simultaneous Chandra, XMM-Newton and BeppoSAX observations of the Seyfert 1 galaxy NGC 3516, taken during 2001 April and Nov. We have investigated the nature of the very flat observed X-ray spectrum. Chandra grating data show the presence of X-ray absorption lines, revealing two distinct components of the absorbing gas, one which is consistent with our previous model of the UV/X-ray absorber while the other, which is outflowing at a velocity of ~1100 km/s has a larger column density and is much more highly ionized. The broad-band spectral characteristics of the X-ray continuum observed with XMM during 2001 April, reveal the presence of a third layer of absorption consisting of a very large column (~2.5 x 10E23 cm^-2) of highly ionized gas with a covering fraction ~50%. This low covering fraction suggests that the absorber lies within a few lt-days of the X-ray source and/or is filamentary in structure. Interestingly, these absorbers are not in thermal equilibrium with one another. The two new components are too highly ionized to be radiatively accelerated, which we suggest is evidence for a hydromagnetic origin for the outflow. Applying our model to the Nov dataset, we can account for the spectral variability primarily by a drop in the ionization states of the absorbers, as expected by the change in the continuum flux. When this complex absorption is accounted for we find the underlying continuum to be typical of Seyfert 1 galaxies. The spectral curvature attributed to the high column absorber, in turn, reduces estimates of the flux and extent of any broad Fe emission line from the accretion disk.Comment: 33 pages, 9 figures, accepted for publication in Ap

Modeling the UBVRI time delays in Mrk 335

We develop a model of time delays between the continuum bands in the Narrow Line Seyfert 1 galaxy Mrk 335 to explain the observed delays measured in this source. We consider two geometries: an accretion disk with fully ionized warm absorber of considerable optical depth, located close to the symmetry axis, and an accretion disk with a hot corona. Both media lead to significant disk irradiation but the disk/corona geometry gives lower values of the time delays. Only the disk/corona models give results consistent with measurements of Sergeev et al., and a low value of the disk inclination is favored. The presence of an optically thick, fully ionized outflow is ruled out at the 2-sigma level.Comment: MNRAS (in press

Mothers' complex talk when sharing books with their toddlers: Book genre matters

This study investigated the influence of book genre (narrative or didactic) on mothers' language use during a book sharing interaction with their 18- to 25-month-olds. Mother-child dyads were videotaped sharing both a narrative and a didactic book, adapted from two commercially available books, and matched in terms of length, quantity of text, and target content. A greater proportion of mothers' talk was complex (i.e., predictions, text-to-life comparisons) during narrative book sharing than during didactic book sharing. Mothers also used a greater variety of verb tenses and referenced more mental states during narrative book sharing. These results differ from findings from previous studies with older children where it has been concluded that didactic books offer greater opportunities for complex talk than narrative books. The results also highlight the importance of taking situational factors into account when investigating parent-child communicative interactions. © The Author(s) 2013

A systematic review:Unfinished nursing care and the impact on the nurse outcomes of job satisfaction, burnout, intention-to-leave and turnover

Aim: To investigate the association of unfinished nursing care on nurse outcomes. Design: Systematic review in line with National Institute for Health and Care Excellence guideline. Data sources: CINAHL, the Cochrane Library, Embase, Medline, ProQuest and Scopus databases were searched up until April 2020. Review methods: Two independent reviewers conducted each stage of the review process: screening eligibility, quality appraisal using Mixed Methods Appraisal Tool; and data extraction. Narrative synthesis compared measurements and outcomes. Results: Nine hospital studies were included, and all but one were cross-sectional multicentre studies with a variety of sampling sizes (136-4169 nurses). Studies had low internal validity implying a high risk of bias. There was also a high potential for bias due to non-response. Only one study explicitly sought to examine nurse outcomes as a primary dependent variable, as most included nurse outcomes as mediating variables. Of the available data, unfinished nursing care was associated with: reduced job satisfaction (5/7 studies); burnout (1/3); and intention-to-leave (2/2). No association was found with turnover (2/2). Conclusion: Unfinished nursing care remains a plausible mediator of negative nurse outcomes, but research is limited to single-country studies and self-reported outcome measures. Given challenges in the sector for nurse satisfaction, recruitment and retention, future research needs to focus on nurse outcomes as a specific aim of inquiry in relation to unfinished nursing care. Impact: Unfinished nursing care has previously been demonstrated to be associated with staffing, education and work environments, with negative associations with patient outcomes (patient satisfaction, medication errors, infections, incidents and readmissions). This study offers new evidence that the impact of unfinished nursing care on nurses is under investigated. Policymakers can prioritize the funding of robust observational studies and quasi-experimental studies with a primary aim to understand the impact of unfinished nursing care on nurse outcomes to better inform health workforce sustainability

Microwave Assisted Synthesis of Py-Im Polyamides

Microwave synthesis was utilized to rapidly build Py-Im polyamides in high yields and purity using Boc-protection chemistry on Kaiser oxime resin. A representative polyamide targeting the 5′-WGWWCW-3′ (W = A or T) subset of the consensus Androgen and Glucocorticoid Response Elements was synthesized in 56% yield after 20 linear steps and HPLC purification. It was confirmed by Mosher amide derivatization of the polyamide that a chiral α-amino acid does not racemize after several additional coupling steps

Morphological characteristics of motor neurons do not determine their relative susceptibility to degeneration in a mouse model of severe spinal muscular atrophy

Spinal muscular atrophy (SMA) is a leading genetic cause of infant mortality, resulting primarily from the degeneration and loss of lower motor neurons. Studies using mouse models of SMA have revealed widespread heterogeneity in the susceptibility of individual motor neurons to neurodegeneration, but the underlying reasons remain unclear. Data from related motor neuron diseases, such as amyotrophic lateral sclerosis (ALS), suggest that morphological properties of motor neurons may regulate susceptibility: in ALS larger motor units innervating fast-twitch muscles degenerate first. We therefore set out to determine whether intrinsic morphological characteristics of motor neurons influenced their relative vulnerability to SMA. Motor neuron vulnerability was mapped across 10 muscle groups in SMA mice. Neither the position of the muscle in the body, nor the fibre type of the muscle innervated, influenced susceptibility. Morphological properties of vulnerable and disease-resistant motor neurons were then determined from single motor units reconstructed in Thy.1-YFP-H mice. None of the parameters we investigated in healthy young adult mice - including motor unit size, motor unit arbor length, branching patterns, motor endplate size, developmental pruning and numbers of terminal Schwann cells at neuromuscular junctions - correlated with vulnerability. We conclude that morphological characteristics of motor neurons are not a major determinant of disease-susceptibility in SMA, in stark contrast to related forms of motor neuron disease such as ALS. This suggests that subtle molecular differences between motor neurons, or extrinsic factors arising from other cell types, are more likely to determine relative susceptibility in SMA