172 research outputs found
Process evaluation for complex interventions in primary care: understanding trials using the normalization process model
Background: the Normalization Process Model is a conceptual tool intended to assist in understanding the factors that affect implementation processes in clinical trials and other evaluations of complex interventions. It focuses on the ways that the implementation of complex interventions is shaped by problems of workability and integration.Method: in this paper the model is applied to two different complex trials: (i) the delivery of problem solving therapies for psychosocial distress, and (ii) the delivery of nurse-led clinics for heart failure treatment in primary care.Results: application of the model shows how process evaluations need to focus on more than the immediate contexts in which trial outcomes are generated. Problems relating to intervention workability and integration also need to be understood. The model may be used effectively to explain the implementation process in trials of complex interventions.Conclusion: the model invites evaluators to attend equally to considering how a complex intervention interacts with existing patterns of service organization, professional practice, and professional-patient interaction. The justification for this may be found in the abundance of reports of clinical effectiveness for interventions that have little hope of being implemented in real healthcare setting
Direct generation of photon triplets using cascaded photon-pair sources
Non-classical states of light, such as entangled photon pairs and number
states, are essential for fundamental tests of quantum mechanics and optical
quantum technologies. The most widespread technique for creating these quantum
resources is the spontaneous parametric down-conversion (SPDC) of laser light
into photon pairs. Conservation of energy and momentum in this process, known
as phase-matching, gives rise to strong correlations which are used to produce
two-photon entanglement in various degrees of freedom. It has been a
longstanding goal of the quantum optics community to realise a source that can
produce analogous correlations in photon triplets, but of the many approaches
considered, none have been technically feasible. In this paper we report the
observation of photon triplets generated by cascaded down-conversion. Here each
triplet originates from a single pump photon, and therefore quantum
correlations will extend over all three photons in a way not achievable with
independently created photon pairs. We expect our photon-triplet source to open
up new avenues of quantum optics and become an important tool in quantum
technologies. Our source will allow experimental interrogation of novel quantum
correlations, the post-selection free generation of tripartite entanglement
without post- selection and the generation of heralded entangled-photon pairs
suitable for linear optical quantum computing. Two of the triplet photons have
a wavelength matched for optimal transmission in optical fibres, ideally suited
for three-party quantum communication. Furthermore, our results open
interesting regimes of non-linear optics, as we observe spontaneous
down-conversion pumped by single photons, an interaction also highly relevant
to optical quantum computing.Comment: 7 pages, 3 figures, 1 table; accepted by Natur
Physical and mental health comorbidity is common in people with multiple sclerosis: nationally representative cross-sectional population database analysis
<b>Background</b> Comorbidity in Multiple Sclerosis (MS) is associated with worse health and higher mortality. This study aims to describe clinician recorded comorbidities in people with MS. <p></p>
<b>Methods</b> 39 comorbidities in 3826 people with MS aged ≥25 years were compared against 1,268,859 controls. Results were analysed by age, gender, and socioeconomic status, with unadjusted and adjusted Odds Ratios (ORs) calculated using logistic regression. <p></p>
<b>Results</b> People with MS were more likely to have one (OR 2.44; 95% CI 2.26-2.64), two (OR 1.49; 95% CI 1.38-1.62), three (OR 1.86; 95% CI 1.69-2.04), four or more (OR 1.61; 95% CI 1.47-1.77) non-MS chronic conditions than controls, and greater mental health comorbidity (OR 2.94; 95% CI 2.75-3.14), which increased as the number of physical comorbidities rose. Cardiovascular conditions, including atrial fibrillation (OR 0.49; 95% CI 0.36-0.67), chronic kidney disease (OR 0.51; 95% CI 0.40-0.65), heart failure (OR 0.62; 95% CI 0.45-0.85), coronary heart disease (OR 0.64; 95% CI 0.52-0.71), and hypertension (OR 0.65; 95% CI 0.59-0.72) were significantly less common in people with MS. <p></p>
<b>Conclusion</b> People with MS have excess multiple chronic conditions, with associated increased mental health comorbidity. The low recorded cardiovascular comorbidity warrants further investigation
Aortic stiffness as a marker of cardiac function and myocardial strain in patients undergoing aortic valve replacement
Background: Cardiac function and myocardial strain are affected by cardiac afterload, which is in part due to the
stiffness of the aortic wall. In this study, we hypothesize that aortic pulse wave velocity (PWV) as a marker of aortic
stiffness correlates with conventional clinical and biochemical markers of cardiac function and perioperative
myocardial strain in aortic valve replacement (AVR).
Methods: Patients undergoing AVR for aortic stenosis between June 2010 and August 2012 were recruited for
inclusion in this study. PWV, NYHA class and left ventricular (LV) function were assessed pre-operatively. PWV was
analysed both as a continuous and dichotomous variable according to age-standardized reference values. B-type
natriuretic peptide (BNP) was measured pre-operatively, and at 3 h and 18-24 h after cardiopulmonary bypass (CPB).
NYHA class, leg edema, and LV function were recorded at follow-up (409 ± 159 days).
Results: Fifty-six patients (16 females) with a mean age of 71 ± 8.4 years were included, with 50 (89%) patients
completing follow-up. The NYHA class of PWV-norm patients was significantly lower than PWV-high patients both
pre- and post-operatively. Multiple logistic regression also highlighted PWV-cut off as an independent predictor of
NYHA class pre- and post-operatively (OR 8.3, 95%CI [2.27,33.33] and OR 14.44, 95%CI [1.49,139.31] respectively). No
significant relationship was observed between PWV and either LV function or plasma BNP.
Conclusion: In patients undergoing AVR for aortic stenosis, PWV is independently related to pre- and post-operative
NYHA class but not to LV function or BNP. These findings provisionally support the use of perioperative PWV as a
non-invasive marker of clinical functional status, which when used in conjunction with biomarkers of myocardial strain
such as BNP, may provide a holistic functional assessment of patients undergoing aortic valve surgery. However, in
order for PWV assessment to be translated into clinical practice and utilised as more than simply a research tool, further
validation is required in the form of larger prospective studies specifically designed to assess the relationship between
PWV and these functional clinical outcomes
Characterization of TgPuf1, a member of the Puf family RNA-binding proteins from Toxoplasma gondii
Health insurance mediation of the Mexican American non-Hispanic white disparity on early breast cancer diagnosis
A high quality assembly of the Nile Tilapia (Oreochromis niloticus) genome reveals the structure of two sex determination regions
Background Tilapias are the second most farmed fishes in the world and a sustainable source of food. Like many other fish, tilapias are sexually dimorphic and sex is a commercially important trait in these fish. In this study, we developed a significantly improved assembly of the tilapia genome using the latest genome sequencing methods and show how it improves the characterization of two sex determination regions in two tilapia species. Results A homozygous clonal XX female Nile tilapia (Oreochromis niloticus) was sequenced to 44X coverage using Pacific Biosciences (PacBio) SMRT sequencing. Dozens of candidate de novo assemblies were generated and an optimal assembly (contig NG50 of 3.3Mbp) was selected using principal component analysis of likelihood scores calculated from several paired-end sequencing libraries. Comparison of the new assembly to the previous O. niloticus genome assembly reveals that recently duplicated portions of the genome are now well represented. The overall number of genes in the new assembly increased by 27.3%, including a 67% increase in pseudogenes. The new tilapia genome assembly correctly represents two recentvasagene duplication events that have been verified with BAC sequencing. At total of 146Mbp of additional transposable element sequence are now assembled, a large proportion of which are recent insertions. Large centromeric satellite repeats are assembled and annotated in cichlid fish for the first time. Finally, the new assembly identifies the long-range structure of both a ~9Mbp XY sex determination region on LG1 in O. niloticus, and a ~50Mbp WZ sex determination region on LG3 in the related species O. aureus. Conclusions This study highlights the use of long read sequencing to correctly assemble recent duplications and to characterize repeat-filled regions of the genome. The study serves as an example of the need for high quality genome assemblies and provides a framework for identifying sex determining genes in tilapia and related fish species
Parathyroid Hormone Treatment Increases Fixation of Orthopedic Implants with Gap Healing: A Biomechanical and Histomorphometric Canine Study of Porous Coated Titanium Alloy Implants in Cancellous Bone
Parathyroid hormone (PTH) administered intermittently is a bone-building peptide. In joint replacements, implants are unavoidably surrounded by gaps despite meticulous surgical technique and osseointegration is challenging. We examined the effect of human PTH(1–34) on implant fixation in an experimental gap model. We inserted cylindrical (10 × 6 mm) porous coated titanium alloy implants in a concentric 1-mm gap in normal cancellous bone of proximal tibia in 20 canines. Animals were randomized to treatment with PTH(1–34) 5 μg/kg daily. After 4 weeks, fixation was evaluated by histomorphometry and push-out test. Bone volume was increased significantly in the gap. In the outer gap (500 μm), the bone volume fraction median (interquartile range) was 27% (20–37%) for PTH and 10% (6–14%) for control. In the inner gap, the bone volume fraction was 33% (26–36%) for PTH and 13% (11–18%) for control. At the implant interface, the bone fraction improved with 16% (11–20%) for PTH and 10% (7–12%) (P = 0.07) for control. Mechanical implant fixation was improved for implants exposed to PTH. For PTH, median (interquartile range) shear stiffness was significantly higher (PTH 17.4 [12.7–39.7] MPa/mm and control 8.8 [3.3–12.4] MPa/mm) (P < 0.05). Energy absorption was significantly enhanced for PTH (PTH 781 [595–1,198.5] J/m2 and control 470 [189–596] J/m2). Increased shear strength was observed but was not significant (PTH 3.0 [2.6–4.9] and control 2.0 [0.9–3.0] MPa) (P = 0.08). Results show that PTH has a positive effect on implant fixation in regions where gaps exist in the surrounding bone. With further studies, PTH may potentially be used clinically to enhance tissue integration in these challenging environments
Complexity absorption : A processual strategic approach to corporate entrepreneurship strategy
The author Haina Zhang acknowledges the support of research grant received from the Lancaster University Research Committee (award reference: SGS21/33). The author is also grateful to Professor David Brown for his suggestions on earlier version of this paper.Peer reviewedPublisher PD
A high quality assembly of the Nile Tilapia (Oreochromis niloticus) genome reveals the structure of two sex determination regions
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