740 research outputs found

    Alarmins in frozen shoulder: a molecular association between inflammation and pain

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    Background: The pathophysiological mechanisms behind proliferation of fibroblasts and deposition of dense collagen matrix in idiopathic frozen shoulder remain unclear. Alarmins (also known as danger signals) are endogenous molecules that are released into the extracellular milieu after infection or tissue injury and that signal cell and tissue damage. Purpose: To investigate whether the presence of alarmins is higher in patients with idiopathic frozen shoulder than in control subjects. Study Design: Controlled laboratory study. Methods: Shoulder capsule samples were collected from 10 patients with idiopathic frozen shoulder and 10 patients with unstable shoulders (control). The samples were stained with hematoxylin and eosin (H&E) and analyzed by immunohistochemistry using antibodies against alarmin molecules including high-mobility group protein B1 (HMGB1), interleukin 33, S100A8, S100A9, and the peripheral nerve marker PGP9.5. Immunoreactivities were rated in a blinded fashion from “none” to “strong.” Immunohistochemical distribution within the capsule was noted. Before surgery, patient-ranked pain frequency, severity, stiffness, and the range of passive shoulder motion were recorded and statistically analyzed. Results: Compared with control patients, patients with frozen shoulder had greater frequency and severity of self-reported pain (P = .02) and more restricted range of motion in all planes (P < .05). H&E-stained capsular tissue from frozen shoulder showed fibroblastic hypercellularity and increased subsynovial vascularity. Immunoreactivity of alarmins was significantly stronger in frozen shoulder capsules compared with control capsules (P < .05). Furthermore, the expression of the alarmin molecule HMGB1 significantly correlated (r > 0.9, P < .05) with the severity of patient-reported pain. Conclusion: This study demonstrates a potential role for key molecular danger signals in frozen shoulder and suggests an association between the expression of danger molecules and the pain experienced by patients

    The challenges of communicating research evidence in practice: perspectives from UK health visitors and practice nurses

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    <p>Background: Health practitioners play a pivotal role in providing patients with up-to-date evidence and health information. Evidence-based practice and patient-centred care are transforming the delivery of healthcare in the UK. Health practitioners are increasingly balancing the need to provide evidence-based information against that of facilitating patient choice, which may not always concur with the evidence base. There is limited research exploring how health practitioners working in the UK, and particularly those more autonomous practitioners such as health visitors and practice nurses working in community practice settings, negotiate this challenge. This research provides a descriptive account of how health visitors and practice nurses negotiate the challenges of communicating health information and research evidence in practice.</p> <p>Methods: A total of eighteen in-depth telephone interviews were conducted in the UK between September 2008 and May 2009. The participants comprised nine health visitors and nine practice nurses, recruited via adverts on a nursing website, posters at a practitioner conference and through recommendation. Thematic analysis, with a focus on constant comparative method, was used to analyse the data.</p> <p>Results: The data were grouped into three main themes: communicating evidence to the critically-minded patient; confidence in communicating evidence; and maintaining the integrity of the patient-practitioner relationship. These findings highlight some of the daily challenges that health visitors and practice nurses face with regard to the complex and dynamic nature of evidence and the changing attitudes and expectations of patients. The findings also highlight the tensions that exist between differing philosophies of evidence-based practice and patient-centred care, which can make communicating about evidence a daunting task.</p> <p>Conclusions: If health practitioners are to be effective at communicating research evidence, we suggest that more research and resources need to be focused on contextual factors, such as how research evidence is negotiated, appraised and communicated within the dynamic patient-practitioner relationship.</p&gt

    Single photon emitters based on Ni/Si related defects in single crystalline diamond

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    We present investigations on single Ni/Si related color centers produced via ion implantation into single crystalline type IIa CVD diamond. Testing different ion dose combinations we show that there is an upper limit for both the Ni and the Si dose 10^12/cm^2 and 10^10/cm^2 resp.) due to creation of excess fluorescent background. We demonstrate creation of Ni/Si related centers showing emission in the spectral range between 767nm and 775nm and narrow line-widths of 2nm FWHM at room temperature. Measurements of the intensity auto-correlation functions prove single-photon emission. The investigated color centers can be coarsely divided into two groups: Drawing from photon statistics and the degree of polarization in excitation and emission we find that some color centers behave as two-level, single-dipole systems whereas other centers exhibit three levels and contributions from two orthogonal dipoles. In addition, some color centers feature stable and bright emission with saturation count rates up to 78kcounts/s whereas others show fluctuating count rates and three-level blinking.Comment: 7 pages, submitted to Applied Physics B, revised versio

    Measuring the context of care in an Australian acute care hospital: a nurse survey

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    BACKGROUND: This study set out to achieve three objectives: to test the application of a context assessment tool in an acute hospital in South Australia; to use the tool to compare context in wards that had undergone an evidence implementation process with control wards; and finally to test for relationships between demographic variables (in particular experience) of nurses being studied (n = 422) with the dimensions of context. METHODS: The Alberta Context Tool (ACT) was administered to all nursing staff on six control and six intervention wards. A total of 217 (62%) were returned (67% from the intervention wards and 56% from control wards). Data were analysed using Stata (v9). The effect of the intervention was analysed using nested (hierarchical) analysis of variance; relationships between nurses' experience and context was examined using canonical correlation analysis. RESULTS: Results confirmed the adaptation and fit of the ACT to one acute care setting in South Australia. There was no difference in context scores between control and intervention wards. However, the tool identified significant variation between wards in many of the dimensions of context. Though significant, the relationship between nurses' experience and context was weak, suggesting that at the level of the individual nurse, few factors are related to context. CONCLUSIONS: Variables operating at the level of the individual showed little relationship with context. However, the study indicated that some dimensions of context (e.g., leadership, culture) vary at the ward level, whereas others (e.g., structural and electronic resources) do not. The ACT also raised a number of interesting speculative hypotheses around the relationship between a measure of context and the capability and capacity of staff to influence it.Timothy J. Schultz and Alison L. Kitso

    Boundary Shape and Casimir Energy

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    Casimir energy changes are investigated for geometries obtained by small but arbitrary deformations of a given geometry for which the vacuum energy is already known for the massless scalar field. As a specific case, deformation of a spherical shell is studied. From the deformation of the sphere we show that the Casimir energy is a decreasing function of the surface to volume ratio. The decreasing rate is higher for less smooth deformations.Comment: 12 page

    Single photon generation by pulsed excitation of a single dipole

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    The fluorescence of a single dipole excited by an intense light pulse can lead to the generation of another light pulse containing a single photon. The influence of the duration and energy of the excitation pulse on the number of photons in the fluorescence pulse is studied. The case of a two-level dipole with strongly damped coherences is considered. The presence of a metastable state leading to shelving is also investigated.Comment: 17 pages, 4 figures, submitted to PR

    Translating clinical training into practice in complex mental health systems: Toward opening the 'Black Box' of implementation

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    <p>Abstract</p> <p>Background</p> <p>Implementing clinical training in a complex health care system is challenging. This report describes two successive trainings programs in one Veterans Affairs healthcare network and the lessons we drew from their success and failures. The first training experience led us to appreciate the value of careful implementation planning while the second suggested that use of an external facilitator might be an especially effective implementation component. We also describe a third training intervention in which we expect to more rigorously test our hypothesis regarding the value of external facilitation.</p> <p>Results</p> <p>Our experiences appear to be consonant with the implementation model proposed by Fixsen. In this paper we offer a modified version of the Fixsen model with separate components related to training and implementation.</p> <p>Conclusion</p> <p>This report further reinforces what others have noted, namely that educational interventions intended to change clinical practice should employ a multilevel approach if patients are to truly benefit from new skills gained by clinicians. We utilize an implementation research model to illustrate how the aims of the second intervention were realized and sustained over the 12-month follow-up period, and to suggest directions for future implementation research. The present report attests to the validity of, and contributes to, the emerging literature on implementation research.</p

    Fluorescent dyes as a probe for the localized field of coupled surface plasmon-related resonances

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    M. Kreiter, T. Neumann, S. Mittler, W. Knoll, and J. Roy Sambles, Physical Review B, Vol. 64, article 075406 (2001). "Copyright © 2001 by the American Physical Society."The fluorescence light of Cy5 dye molecules in the vicinity of a metal grating is studied for varying directions of both the exciting and the emitted light. A different angular dependence of the intensity of the emitted light is observed for different directions of excitation. Model calculations that take into account the localization of the electrical field of grating-coupled surface plasmon-related resonances are in good agreement with the experimental observations. In addition, the spatially inhomogenous photobleaching of the dye in the field of the coupled resonances is experimentally observed. These results can be viewed both as a way to use chromophores as molecular probes for the localized electrical near field of coupled surface plasmon-related resonances and as a way to manipulate dye molecules on a submicron scale

    Sexual selection protects against extinction

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    Reproduction through sex carries substantial costs, mainly because only half of sexual adults produce offspring1. It has been theorized that these costs could be countered if sex allows sexual selection to clear the universal fitness constraint of mutation load2,3,4. Under sexual selection, competition between (usually) males and mate choice by (usually) females create important intraspecific filters for reproductive success, so that only a subset of males gains paternity. If reproductive success under sexual selection is dependent on individual condition, which is contingent to mutation load, then sexually selected filtering through ‘genic capture’5 could offset the costs of sex because it provides genetic benefits to populations. Here we test this theory experimentally by comparing whether populations with histories of strong versus weak sexual selection purge mutation load and resist extinction differently. After evolving replicate populations of the flour beetle Tribolium castaneum for 6 to 7 years under conditions that differed solely in the strengths of sexual selection, we revealed mutation load using inbreeding. Lineages from populations that had previously experienced strong sexual selection were resilient to extinction and maintained fitness under inbreeding, with some families continuing to survive after 20 generations of sib × sib mating. By contrast, lineages derived from populations that experienced weak or non-existent sexual selection showed rapid fitness declines under inbreeding, and all were extinct after generation 10. Multiple mutations across the genome with individually small effects can be difficult to clear, yet sum to a significant fitness load; our findings reveal that sexual selection reduces this load, improving population viability in the face of genetic stress.We thank the Natural Environment Research Council and the Leverhulme Trust for financial support, D. Edward for statistical advice and colleagues at the 2013 Biology of Sperm meeting for comments that improved analytical design and interpretation.Peer reviewedPeer Reviewe