What do parents of children with dysphagia think about their MDT? A qualitative study

Objectives: To seek the experiences and perspectives of parents caring for children with dysphagia, with emphasis on their experiences of working within their child’s multidisciplinary team (MDT) Setting: This research was completed in community settings, within families’ homes across the UK. Participants: Fourteen families self-selected to participate in the study. Criteria specified that participants must care for a child under the age of 18 and to decrease ambiguity the term ‘diagnosis of dysphagia’ was defined as the need for modified (thickened) fluids. Exclusion criteria: caring for an adult over the age of 18; diet and fluid modifications for reasons other than dysphagia (e.g. for symptomatic treatment of Gastro-oesophageal reflux disease (GORD). Participants were interviewed within their homes using a semi-structured questionnaire and data was analysed using a descriptive phenomenological approach through use of thematic coding and constant comparison. Themes and relationships were inductively generated from the data. Results: Participants universally expressed a desire to be involved with their child’s multidisciplinary team; this study identified the following facilitators and barriers to collaboration: Accessing Services, Professional Knowledge, and Professional Skillset. Participants described three means of responding to these barriers: Reacting Emotionally, Seeking Solutions, and Making Decisions. Conclusions: This study recorded in-depth reports of participants’ experiences of working with healthcare providers. Despite government-driven efforts towards person-centred health and social care, participants shared accounts of times when this has not occurred, describing a negative impact on the well-being and quality of life of their child and family

Role of prostacyclin in pulmonary hypertension

Date of Acceptance: 11/12/2014 This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY-4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.Prostacyclin is a powerful cardioprotective hormone released by the endothelium of all blood vessels. Prostacyclin exists in equilibrium with other vasoactive hormones and a disturbance in the balance of these factors leads to cardiovascular disease including pulmonary arterial hypertension. Since it’s discovery in the 1980s concerted efforts have been made to make the best therapeutic utility of prostacyclin, particularly in the treatment of pulmonary arterial hypertension. This has centred on working out the detailed pharmacology of prostacyclin and then synthesising new molecules based on its structure that are more stable or more easily tolerated. In addition, newer molecules have been developed that are not analogues of prostacyclin but that target the receptors that prostacyclin activates. Prostacyclin and related drugs have without doubt revolutionised the treatment and management of pulmonary arterial hypertension but are seriously limited by side effects within the systemic circulation. With the dawn of nanomedicine and targeted drug or stem cell delivery systems it will, in the very near future, be possible to make new formulations of prostacyclin that can evade the systemic circulation allowing for safe delivery to the pulmonary vessels. In this way, the full therapeutic potential of prostacyclin can be realised opening the possibility that pulmonary arterial hypertension will become, if not curable, a chronic manageable disease that is no longer fatal. This review discusses these and other issues relating to prostacyclin and its use in pulmonary arterial hypertensionPeer reviewedFinal Published versio

Multifluid, Magnetohydrodynamic Shock Waves with Grain Dynamics II. Dust and the Critical Speed for C Shocks

This is the second in a series of papers on the effects of dust on multifluid, MHD shock waves in weakly ionized molecular gas. We investigate the influence of dust on the critical shock speed, v_crit, above which C shocks cease to exist. Chernoff showed that v_crit cannot exceed the grain magnetosound speed, v_gms, if dust grains are dynamically well coupled to the magnetic field. We present numerical simulations of steady shocks where the grains may be well- or poorly coupled to the field. We use a time-dependent, multifluid MHD code that models the plasma as a system of interacting fluids: neutral particles, ions, electrons, and various ``dust fluids'' comprised of grains with different sizes and charges. Our simulations include grain inertia and grain charge fluctuations but to highlight the essential physics we assume adiabatic flow, single-size grains, and neglect the effects of chemistry. We show that the existence of a phase speed v_phi does not necessarily mean that C shocks will form for all shock speeds v_s less than v_phi. When the grains are weakly coupled to the field, steady, adiabatic shocks resemble shocks with no dust: the transition to J type flow occurs at v_crit = 2.76 v_nA, where v_nA is the neutral Alfven speed, and steady shocks with v_s > 2.76 v_nA are J shocks with magnetic precursors in the ion-electron fluid. When the grains are strongly coupled to the field, v_crit = min(2.76 v_nA, v_gms). Shocks with v_crit < v_s < v_gms have magnetic precursors in the ion-electron-dust fluid. Shocks with v_s > v_gms have no magnetic precursor in any fluid. We present time-dependent calculations to study the formation of steady multifluid shocks. The dynamics differ qualitatively depending on whether or not the grains and field are well coupled.Comment: 43 pages with 17 figures, aastex, accepted by The Astrophysical Journa

10- m imaging of the bipolar protoplanetary nebula Mz-3

A 10-µm image is presented of the bipolar protoplanetary nebula Mz-3 made at the 3.9-m Anglo-Australian Telescope using the NIMPOL mid-infrared imaging polarimeter. The image shows extended emission from warm (110–130 K) dust both to the north and to the south of the central star, which correlates well with the visible bipolar lobes. The observed surface brightness of this emission is consistent with radiative heating of the dust by both direct stellar illumination and trapped Lyman α photons. Emission in excess of the point-source profile indicates that there is also an extended shell of dust surrounding the central star

Investigating partner involvement in pregnancy and identifying barriers and facilitators to participating as a couple in a digital healthy eating and physical activity intervention

BACKGROUND: Maternal obesity and excessive gestational weight gain are associated with adverse maternal and foetal health outcomes. Interventions targeting dietary and physical activity behaviours during pregnancy have typically been directed at women only. A digital intervention targeting couples could encourage expectant parents to support each other in improving energy balance (dietary and physical activity) behaviours. AIMS: This study aimed to investigate the role partners play in pregnant women’s energy balance behaviours, and to identify barriers and facilitators to participating as a couple in a digital intervention to encourage healthy eating and physical activity in pregnancy. METHODS: A qualitative design combined online focus groups and telephone interviews. Three focus groups were held with men (n = 15) and one mini focus group (n = 3) and 12 telephone interviews were conducted with women. Participants were either in the last trimester of pregnancy or had a baby under 18 months old. Most were from more deprived population groups where prevalence of maternal obesity is higher. Data were analysed thematically. Barriers and facilitators to participating as a couple in a digital intervention were mapped to the COM-B model and the Theoretical Domains Framework. RESULTS: Four main themes were identified; partner involvement and support; partner understanding of good energy balance behaviours; couple concordance of energy balance behaviours; partner influence on her energy balance behaviours. Most facilitators to participating in a digital intervention as a couple fell within the Reflective Motivation domain of COM-B. Men were motivated by the desire to be supportive partners and good role models. Women were motivated by their belief that partner involvement would improve their success in achieving goals and enhance couple-bonding. Other facilitators included concordance in dietary behaviours (Physical Opportunity), healthcare practitioner recommendation, perceptions of pregnancy as ‘ours’ (Social Opportunity) and feeling supported and involved (Automatic Motivation). Barriers were rarely mentioned but included potential for partner conflict, perceptions of pregnancy as ‘hers’ and economic constraints. CONCLUSIONS: An opportunity exists to harness partner support to improve maternal energy balance behaviours. Barriers and facilitators to participating in a digital intervention as a couple indicate its potential to benefit emotional and relationship wellbeing in addition to physical health

Hierarchical Analysis of Conformational Dynamics in Biomolecules: Transition Networks of Metastable States

Molecular dynamics simulation generates large quantities of data that must be interpreted using physically meaningful analysis. A common approach is to describe the system dynamics in terms of transitions between coarse partitions of conformational space. In contrast to previous work that partitions the space according to geometric proximity, the authors examine here clustering based on kinetics, merging configurational microstates together so as to identify long-lived, i.e., dynamically metastable, states. As test systems microsecond molecular dynamics simulations of the polyalanines Ala8 and Ala12 are analyzed. Both systems clearly exhibit metastability, with some kinetically distinct metastable states being geometrically very similar. Using the backbone torsion rotamer pattern to define the microstates, a definition is obtained of metastable states whose lifetimes considerably exceed the memory associated with interstate dynamics, thus allowing the kinetics to be described by a Markov model. This model is shown to be valid by comparison of its predictions with the kinetics obtained directly from the molecular dynamics simulations. In contrast, clustering based on the hydrogen-bonding pattern fails to identify long-lived metastable states or a reliable Markov model. Finally, an approach is proposed to generate a hierarchical model of networks, each having a different number of metastable states. The model hierarchy yields a qualitative understanding of the multiple time and length scales in the dynamics of biomolecule

Wavelength dependent ac-Stark shift of the 1S0 - 3P1 transition at 657 nm in Ca

We have measured the ac-Stark shift of the 4s2 1S0 - 4s4p 3P1 line in 40Ca for perturbing laser wavelengths between 780 nm and 1064 nm with a time domain Ramsey-Borde atom interferometer. We found a zero crossing of the shift for the mS = 0 - mP = 0 transition and \sigma polarized perturbation at 800.8(22) nm. The data was analyzed by a model deriving the energy shift from known transition wavelengths and strengths. To fit our data, we adjusted the Einstein A coefficients of the 4s3d 3D - 4s4p 3P and 4s5s 3S - 4s4p 3P fine structure multiplets. With these we can predict vanishing ac-Stark shifts for the 1S0 m = 0 - 3P1 m = 1 transition and \sigma- light at 983(12) nm and at 735.5(20) nm for the transition to the 3P0 level.Comment: 8 pages, 5 figures, 2 table