Haemorrhoids

Clinical information monographHaemorrhoids are vascular-rich connective tissue cushions located within the anal canal. Internal haemorrhoids lie proximal to the dentate line in the anal canal, whereas external haemorrhoids are located distal to the dentate line. Haemorrhoidal disease presents as painless rectal bleeding or sudden onset of perianal pain with a tender palpable perianal mass. Diagnosis is confirmed with visualisation of the protruding tissue or anoscopic visualisation. Treatment includes increasing dietary fibre, rubber band ligation, infrared photocoagulation, sclerotherapy, or surgical haemorrhoidectomy. Complications include recurrence or worsening of symptoms, excessive bleeding, non-reducible prolapse, and, rarely, pelvic sepsis

Alternative approaches to achieving community safety and well-being across law enforcement and criminal justice: Western European findings

This paper provides the results from Western Europe of a wider project (Envisaging the Future of Policing and Public Health Globally) for the Global Law Enforcement and Public Health Association (GLEPHA) which aimed to identify policing and public health alternative initiatives to provide community safety and well-being. A desktop review of projects that included evaluation evidence and/or impact of innovative delivery were selected for the study. The criteria allowed the inclusion of international, national, regional, and local initiatives that fit the broader aims of the global “envisaging the future” GLEPHA project. In total, 41 projects were reviewed with varying levels of information on approach and evaluation. Data capture recorded the country, location, funder details, themes (e.g., violence, mental health, drugs), key words, program descriptions, and any links and key findings from evaluation studies. A number of key themes, drivers, and challenges were identified in collaborative work between policing and public health. These included elements of communication and generating a shared language, the need for evaluation to be embedded in the project plan and mobilisation, and the problems with “hot-topic” issues and short-term funding. This paper also outlines two case studies of projects within Western Europe: Violence Reduction Units in the United Kingdom, and the Stockholm prevents Alcohol and Drug Problems (STAD). Key aspects of these projects are presented and the successes and potential challenges discussed. Key recommendations regarding the future of law enforcement and public health–related initiatives are discussed

Unexpected features of branched flow through high-mobility two-dimensional electron gases

GaAs-based two-dimensional electron gases (2DEGs) show a wealth of remarkable electronic states, and serve as the basis for fast transistors, research on electrons in nanostructures, and prototypes of quantum-computing schemes. All these uses depend on the extremely low levels of disorder in GaAs 2DEGs, with low-temperature mean free paths ranging from microns to hundreds of microns. Here we study how disorder affects the spatial structure of electron transport by imaging electron flow in three different GaAs/AlGaAs 2DEGs, whose mobilities range over an order of magnitude. As expected, electrons flow along narrow branches that we find remain straight over a distance roughly proportional to the mean free path. We also observe two unanticipated phenomena in high-mobility samples. In our highest-mobility sample we observe an almost complete absence of sharp impurity or defect scattering, indicated by the complete suppression of quantum coherent interference fringes. Also, branched flow through the chaotic potential of a high-mobility sample remains stable to significant changes to the initial conditions of injected electrons.Comment: 22 pages, 4 figures, 1 tabl

The scalar gluonium correlator: large-beta_0 and beyond

The investigation of the scalar gluonium correlator is interesting because it carries the quantum numbers of the vacuum and the relevant hadronic current is related to the anomalous trace of the QCD energy-momentum tensor in the chiral limit. After reviewing the purely perturbative corrections known up to next-next-to-leading order, the behaviour of the correlator is studied to all orders by means of the large-beta_0 approximation. Similar to the QCD Adler function, the large-order behaviour is governed by the leading ultraviolet renormalon pole. The structure of infrared renormalon poles, being related to the operator product expansion are also discussed, as well as a low-energy theorem for the correlator that provides a relation to the renormalisation group invariant gluon condensate, and the vacuum matrix element of the trace of the QCD energy-momentum tensor.Comment: 14 pages, references added, discussion of IR renormalon pole at u=3 extended, similar version to appear in JHE

Substellar and low-mass dwarf identification with near-infrared imaging space observatories

AIMS: We aim to evaluate the near-infrared colors of brown dwarfs as observed with four major infrared imaging space observatories: the Hubble Space Telescope (HST), the James Webb Space Telescope (JWST), the Euclid mission, and the WFIRST telescope. METHODS: We used the SPLAT SPEX/ISPEX spectroscopic library to map out the colors of the M-, L-, and T-type dwarfs. We have identified which color-color combination is optimal for identifying broad type and which single color is optimal to then identify the subtype (e.g., T0-9). We evaluated each observatory separately as well as the narrow-field (HST and JWST) and wide-field (Euclid and WFIRST) combinations. RESULTS: The Euclid filters perform poorly typing brown dwarfs and WFIRST performs only marginally better, despite a wider selection of filters. WFIRST's W146 and F062 combined with Euclid's Y-band discriminates somewhat better between broad brown dwarf categories. However, subtyping with any combination of Euclid and WFIRST observations remains uncertain due to the lack of medium or narrow-band filters. We argue that a medium band added to the WFIRST filter selection would greatly improve its ability to preselect brown dwarfs its imaging surveys. CONCLUSIONS: The HST filters used in high-redshift searches are close to optimal to identify broad stellar type. However, the addition of F127M to the commonly used broad filter sets would allow for unambiguous subtyping. An improvement over HST is one of two broad and medium filter combinations on JWST: pairing F140M with either F150W or F162M discriminates very well between subtypes

Characterizing Family Physicians Who Refer to Telepsychiatry in Ontario

INTRODUCTION: Telepsychiatry can improve access to psychiatric services for those who otherwise cannot easily access care. Family physicians are gatekeepers to specialized care in Ontario, so it is essential to understand predictors relating to referrals to telepsychiatry to better plan services and increase telepsychiatry adoption. METHODS: This study used an annual retrospective cross-sectional study design to compare physicians who referred their patients to telepsychiatry each year from fiscal year (FY) 2008 to FY 2016. A 1-year (FY 2016) comparison of family physicians who referred to telepsychiatry (FPTs) compared to family physicians who did not refer to telepsychiatry (FPNTs) matched (1:2) by region was also conducted. Finally, we used statistical modeling to understand the predictors of referring to telepsychiatry among physicians. RESULTS: Between FY 2008 and FY 2016, the number of patients receiving telepsychiatry increased from 925 visits to 13,825 visits. Thirty-two percent of Ontario primary care physicians referred to telepsychiatry in 2016. Several characteristics were notably different between FPTs and FPNTs: FPTs were more likely to be from a residence with less than 10,000 people, to have more nurse practitioners in the practice, and to be from a family health team than FPNTs. Rostered patients of FPTs were more likely to reside in rural areas, have more clinical complexity, and to utilize more mental health services compared to FPNTs. CONCLUSIONS: There has been an increase in the use of telepsychiatry by patients and family physicians over the study period, although there remains opportunity for significant growth. Family physicians who live in rural areas, are part of an FHT, have more NPs, with more rural and complex patients were more likely to refer to telepsychiatry. As recent pro-telemedicine policies support the growth of telepsychiatry, this study will serve as an important baseline

Relativistic nuclear model with point-couplings constrained by QCD and chiral symmetry

We derive a microscopic relativistic point-coupling model of nuclear many-body dynamics constrained by in-medium QCD sum rules and chiral symmetry. The effective Lagrangian is characterized by density dependent coupling strengths, determined by chiral one- and two-pion exchange and by QCD sum rule constraints for the large isoscalar nucleon self-energies that arise through changes of the quark condensate and the quark density at finite baryon density. This approach is tested in the analysis of the equations of state for symmetric and asymmetric nuclear matter, and of bulk and single-nucleon properties of finite nuclei. In comparison with purely phenomenological mean-field approaches, the built-in QCD constraints and the explicit treatment of pion exchange restrict the freedom in adjusting parameters and functional forms of density dependent couplings. It is shown that chiral (two-pion exchange) fluctuations play a prominent role for nuclear binding and saturation, whereas strong scalar and vector fields of about equal magnitude and opposite sign, induced by changes of the QCD vacuum in the presence of baryonic matter, generate the large effective spin-orbit potential in finite nuclei.Comment: 46 pages, 12 figures, uses elsart.cls, revised version, to appear in Nucl.Phys. A735 (2004) 449-48

Connectivity between mPFC and PCC predicts post‐choice attitude change: The self‐referential processing hypothesis of choice justification

Prior research shows that after making a choice, decision makers shift their attitudes in a choice‐congruous direction. Although this post‐choice attitude change effect is robust, the neural mechanisms underlying it are poorly understood. Here, we tested the hypothesis that decision makers elaborate on their choice in reference to self‐knowledge to justify the choice they have made. This self‐referential processing of the choice is thought to play a pivotal role in the post‐choice attitude change. Twenty‐four young American adults made a series of choices. They also rated their attitudes toward the choice options before and after the choices. In support of the current hypothesis, we found that changes in functional connectivity between two putative self‐regions (medial prefrontal cortex and posterior cingulate cortex/precuneus]) during the post‐choice (vs. pre‐choice) rating of the chosen options predicted the post‐choice shift of the attitudes toward the chosen options. This finding is the first to suggest that cognitive integration of various self‐relevant cognitions is instrumental in fostering post‐choice attitude change. Hum Brain Mapp 37:3810–3820, 2016. © 2016 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134093/1/hbm23277_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134093/2/hbm23277.pd

H-ficolin binds Aspergillus fumigatus leading to activation of the lectin complement pathway and modulation of lung epithelial immune responses.

Aspergillus fumigatus is an opportunistic fungal pathogen that typically infects the lungs of immunocompromised patients leading to a high mortality. H-Ficolin, an innate immune opsonin, is produced by type II alveolar epithelial cells and could participate in lung defences against infections. Here, we used the human type II alveolar epithelial cell line, A549, to determine the involvement of H-ficolin in fungal defence. Additionally, we investigated the presence of H-ficolin in bronchoalveolar lavage fluid from transplant patients during pneumonia. H-Ficolin exhibited demonstrable binding to A. fumigatus conidia via l-fucose, d-mannose and N-acetylglucosamine residues in a calcium- and pH-dependent manner. Moreover, recognition led to lectin complement pathway activation and enhanced fungal association with A549 cells. Following recognition, H-ficolin opsonization manifested an increase in interleukin-8 production from A549 cells, which involved activation of the intracellular signalling pathways mitogen-activated protein kinase MAPK kinase 1/2, p38 MAPK and c-Jun N-terminal kinase. Finally, H-ficolin concentrations were significantly higher in bronchoalveolar lavage fluid of patients with lung infections compared with control subjects (n = 16; P = 0·00726). Receiver operating characteristics curve analysis further highlighted the potential of H-ficolin as a diagnostic marker for lung infection (area under the curve = 0·77; P < 0·0001). Hence, H-ficolin participates in A. fumigatus defence through the activation of the lectin complement pathway, enhanced fungus-host interactions and modulated immune responses