Non-stationary dynamo & magnetospheric accretion processes of the classical T Tauri star V2129 Oph

We report here the first results of a multi-wavelength campaign focussing on magnetospheric accretion processes of the classical TTauri star (cTTS) V2129Oph. In this paper, we present spectropolarimetric observations collected in 2009 July with ESPaDOnS at the Canada-France-Hawaii Telescope (CFHT). Circularly polarised Zeeman signatures are clearly detected, both in photospheric absorption and accretion-powered emission lines, from time-series of which we reconstruct new maps of the magnetic field, photospheric brightness and accretion-powered emission at the surface of V2129Oph using our newest tomographic imaging tool - to be compared with those derived from our old 2005 June data set, reanalyzed in the exact same way. We find that in 2009 July, V2129Oph hosts octupolar & dipolar field components of about 2.1 & 0.9kG respectively, both tilted by about 20deg with respect to the rotation axis; we conclude that the large-scale magnetic topology changed significantly since 2005 June (when the octupole and dipole components were about 1.5 and 3 times weaker respectively), demonstrating that the field of V2129Oph is generated by a non-stationary dynamo. We also show that V2129Oph features a dark photospheric spot and a localised area of accretion-powered emission, both close to the main surface magnetic region (hosting fields of up to about 4kG in 2009 July). We finally obtain that the surface shear of V2129Oph is about half as strong as solar. From the fluxes of accretion-powered emission lines, we estimate that the observed average logarithmic accretion rate (in Msun/yr) at the surface of V2129Oph is -9.2+-0.3 at both epochs, peaking at -9.0 at magnetic maximum. It implies in particular that the radius at which the magnetic field of V2129Oph truncates the inner accretion disc is 0.93x and 0.50x the corotation radius in 2009 July and 2005 June respectively.Comment: MNRAS in press - 16 pages, 9 figure

Value of risk scores in the decision to palliate patients withruptured abdominal aortic aneurysm

Background: The aim of this study was to develop a 48‐h mortality risk score, which included morphology data, for patients with ruptured abdominal aortic aneurysm presenting to an emergency department, and to assess its predictive accuracy and clinical effectiveness in triaging patients to immediate aneurysm repair, transfer or palliative care. Methods: Data from patients in the IMPROVE (Immediate Management of the Patient With Ruptured Aneurysm: Open Versus Endovascular Repair) randomized trial were used to develop the risk score. Variables considered included age, sex, haemodynamic markers and aortic morphology. Backwards selection was used to identify relevant predictors. Predictive performance was assessed using calibration plots and the C‐statistic. Validation of the newly developed and other previously published scores was conducted in four external populations. The net benefit of treating patients based on a risk threshold compared with treating none was quantified. Results: Data from 536 patients in the IMPROVE trial were included. The final variables retained were age, sex, haemoglobin level, serum creatinine level, systolic BP, aortic neck length and angle, and acute myocardial ischaemia. The discrimination of the score for 48‐h mortality in the IMPROVE data was reasonable (C‐statistic 0·710, 95 per cent c.i. 0·659 to 0·760), but varied in external populations (from 0·652 to 0·761). The new score outperformed other published risk scores in some, but not all, populations. An 8 (95 per cent c.i. 5 to 11) per cent improvement in the C‐statistic was estimated compared with using age alone. Conclusion: The assessed risk scores did not have sufficient accuracy to enable potentially life‐saving decisions to be made regarding intervention. Focus should therefore shift to offering repair to more patients and reducing non‐intervention rates, while respecting the wishes of the patient and family

Web-based multimodal graphs for visually impaired people

This paper describes the development and evaluation of Web-based multimodal graphs designed for visually impaired and blind people. The information in the graphs is conveyed to visually impaired people through haptic and audio channels. The motivation of this work is to address problems faced by visually impaired people in accessing graphical information on the Internet, particularly the common types of graphs for data visualization. In our work, line graphs, bar charts and pie charts are accessible through a force feedback device, the Logitech WingMan Force Feedback Mouse. Pre-recorded sound files are used to represent graph contents to users. In order to test the usability of the developed Web graphs, an evaluation was conducted with bar charts as the experimental platform. The results showed that the participants could successfully use the haptic and audio features to extract information from the Web graphs

Determining optimal outcome measures in a trial investigating no routine gastric residual volume measurement in critically ill children

Background Choosing trial outcome measures is important. When outcomes are not clinically relevant or important to parents/patients, trial evidence is less likely to be implemented into practice. This study aimed to determine optimal outcome measures for a trial of no routine gastric residual volume measurement in critically ill children. Methods: A mixed methods approach: a focused literature review, parent and clinician interviews, a modified two-round Delphi and a stakeholder consensus meeting. Results: The review generated 13 outcomes. 14 Pediatric Intensive Care Unit (PICU) parents proposed 3 additional outcomes, these 16 were then rated by 28 clinicians in Delphi round 1. Six further outcomes were proposed, and 22 outcomes were rated in the second round. No items were voted ‘consensus out’. The 18 ‘no-consensus’ items were voted in a face-to-face meeting by 30 participants. The final 12 outcome measures were: Time to reach energy targets; ventilator associated pneumonia; vomiting; time enteral feeds withheld per 24 hour; necrotizing enterocolitis; length of invasive ventilation; PICU length of stay; mortality; change in weight and markers of feed intolerance: parenteral nutrition administered; feed formula altered and changing to post-pyloric feeds all secondary to feed intolerance. Conclusion: We have identified 12 outcomes for a trial of no gastric residual volume measurement through a multi-stage process, seeking views of parents and clinicians. Clinical Relevancy statement: Twelve relevant outcomes have been identified for a trial of no routine gastric residual volume measurement in critically ill children

A survey to investigate the association of pain, foot disability and quality of life with corns

Background Corns are a common foot problem affecting a large proportion of the population. This study describes the characteristics of corns experienced by 201 participants taking part in a randomised controlled trial to investigate associations between demographic and corn parameters on pain, foot related disability and quality of life (QoL). Methods Pain from the main (index) corn was measured using a visual analogue scale (VAS); foot related disability was assessed with the Foot Disability Questionnaire (now known as the Manchester Foot Pain and Disability Index) and quality of life was recorded with the EQ-5D questionnaire. The effect of demographic and corn parameters on the pain and quality of life outcomes was assessed with analysis of variance (ANOVA) methods. The effect of the same factors on a linear combination of the foot-related disability outcome measures was assessed using multivariate ANOVA methods. Pain was also tested for its mediating properties on the causal pathway between the independent variables and quality of life. Results The mean pain score was 5.29 points on a 10 cm VAS, with females reporting substantively higher pain levels than males. Age affected foot-related disability, with lower levels on all domains of the MFPDI reported in older participants; each year of advancing age was associated with falls of: 0.009 points on the Concern about Appearance (CA) domain; 0.047 points on the Functional Limitation (FL) domain and 0.048 points on the Pain Intensity (PI) domain. Sex and corn type also affected disability, with higher scores reported by females and participants with plantar corns. Conclusions The effect of pain was shown to mediate the relationship between sex and foot-related disability. The presence of plantar corns has a more detrimental effect on QoL than dorsal/inter-digital corns

Defining goal terms in development and health

YesMost academic literature uses ‘goal’, ‘aim’, ‘objective’ and ‘target’ as synonymous terms, but development and healthcare sectors define them as distinct etymological entities with varied and confusing interpretations. This review sought to constructively harmonise and differentiate each definition using a thematic framework. An inductive synthesis of definitions of the goal terms collected from 22 literature sources selected through a systematic internet search. Thirty-three specific definitions were reduced through serial category-building to single general definitions, and a set of theoretical themes generated as characteristic framework of each goal. Seven conceptual themes evolved from the synthesis, including the object, scope, hierarchy, timeframe, measurability, significance and expression of each goal term. Two terms, ‘goal’ and ‘aim’ are thematically similar as broad objects of immeasurable terminal impact, with a long-term timeframe. They signify organisational success, expressed as general purpose statements. ‘Objective’ is differentiated as a specific object of measurable intermediate outcome, with short-term timeframe. It signifies intervention effectiveness, expressed as a SMART statement. ‘Target’ is simply a specific quantifiable level of an indicator. Goal, aim, objective and target are conceptually different. New frameworks for writing complete goal statements are proposed, including impact and timeframe; and outcome, indicator and timeframe frameworks for aim and objective respectivel

Do self-reported intentions predict clinicians behaviour: a systematic review.

Background: Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice. Several interventions have been shown to be effective in changing health care professionals' behaviour, but heterogeneity within interventions, targeted behaviours, and study settings make generalisation difficult. Therefore, it is necessary to identify the 'active ingredients' in professional behaviour change strategies. Theories of human behaviour that feature an individual's "intention" to do something as the most immediate predictor of their behaviour have proved to be useful in non-clinical populations. As clinical practice is a form of human behaviour such theories may offer a basis for developing a scientific rationale for the choice of intervention to use in the implementation of new practice. The aim of this review was to explore the relationship between intention and behaviour in clinicians and how this compares to the intention-behaviour relationship in studies of non-clinicians. Methods: We searched: PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Science/Social science citation index, Current contents (social & behavioural med/clinical med), ISI conference proceedings, and Index to Theses. The reference lists of all included papers were checked manually. Studies were eligible for inclusion if they had: examined a clinical behaviour within a clinical context, included measures of both intention and behaviour, measured behaviour after intention, and explored this relationship quantitatively. All titles and abstracts retrieved by electronic searching were screened independently by two reviewers, with disagreements resolved by discussion. Discussion: Ten studies were found that examined the relationship between intention and clinical behaviours in 1623 health professionals. The proportion of variance in behaviour explained by intention was of a similar magnitude to that found in the literature relating to non-health professionals. This was more consistently the case for studies in which intention-behaviour correspondence was good and behaviour was self-reported. Though firm conclusions are limited by a smaller literature, our findings are consistent with that of the non-health professional literature. This review, viewed in the context of the larger populations of studies, provides encouragement for the contention that there is a predictable relationship between the intentions of a health professional and their subsequent behaviour. However, there remain significant methodological challenges

The epistemological model of disability, and its role in understanding passive exclusion in eighteenth and nineteenth century protestant educational asylums

This article examines how the process of constructing knowledge on impairment has affected the institutional construction of an ethic of disability. Its primary finding is that the process of creating knowledge in a number of historical contexts was influenced more by traditions and the biases of philosophers and educators in order to signify moral and intellectual superiority, than by a desire to improve the lives of disabled people through education. The article illustrates this epistemological process in a case study of the development of Protestant asylums in the latter years of the nineteenth century

Recurrent cardiac events in patients with idiopathic ventricular fibrillation, excluding patients with the Brugada syndrome

BACKGROUND: The recurrence of cardiac events in patients with idiopathic ventricular fibrillation (VF) excluding patients with the Brugada syndrome is unclear since this entity remains present in previous studies. METHODS: Since 1992, 18 patients (72% male) with idiopathic VF out of 455 ICD implants were treated with an implantable cardioverter defibrillator (ICD). The mean age at first ICD implantation was 42 ± 14 years. Brugada syndrome, as well as other primary electrical diseases (e.g. long QT), were systematically excluded in all patients by the absence of the typical electrocardiogram (ST elevation in the right precordial leads) at rest and/or after pharmacological tests (ajmaline, flecainide, or procainamide). Recurrence of cardiac events was prospectively assessed. RESULTS: During a mean follow-up period of 41 ± 27 months, VF recurrence with appropriate shock occurred in 7 patients (39%) covering a total of 27 shocks. The median time to first appropriate shock was 12 ± 9 months. There were no deaths. In the electrophysiological study, 39% of patients were inducible, but inducibility failed to predict subsequent arrhythmic events. Forty-four percent of patients suffered 21 inappropriate shocks, which were caused by sinus tachycardia, atrial arrhythmias or lead malfunction. CONCLUSION: Idiopathic ventricular fibrillation patients have a high recurrence rate of potentially fatal ventricular arrhythmias, excluding patients with the Brugada syndrome or other known causes. ICD prevents sudden cardiac death but inappropriate shocks remained a major issue in this young and active population