Synthesis of 3,6-Bis(5’-bromo-3’-indolyl)-1,4-dimethypiperazine-2,5-dione

The one-pot synthesis of 3,6-bis(5’-bromo-3’-indolyl)-1,4-dimethylpiperazine- 2,5-dione is reported. Sarcosine anhydride is brominated and immediately reacted with 5-bromoindole to produce the product, which is characterized by 1H NMR, MS and microanalysis

Effects of the Selective Serotonin Reuptake Inhibitor Fluoxetine on Counterregulatory Responses to Hypoglycemia in Individuals With Type 1 Diabetes

OBJECTIVE—Previous work has demonstrated that chronic administration of the serotonin reuptake inhibitor (SSRI) fluoxetine augments counterregulatory responses to hypoglycemia in healthy humans. However, virtually no information exists regarding the effects of fluoxetine on integrated physiological counterregulatory responses during hypoglycemia in type 1 diabetes. Therefore, the specific aim of this study was to test the hypothesis that 6-week use of the SSRI fluoxetine would amplify autonomic nervous system (ANS) counterregulatory responses to hypoglycemia in individuals with type 1 diabetes

Implementation of a Collaborative HIV and Hepatitis C Screening Program in Appalachian Urgent Care Settings

Introduction: With the current hepatitis C (HCV) epidemic in the Appalachian region and the risk of human immunodeficiency virus (HIV) co-infection, there is a need for increased secondary prevention efforts. The purpose of this study was to implement routine HIV and HCV screenings in the urgent care setting through the use of an electronic medical record (EMR) to increase a provider’s likelihood of testing eligible patients. Methods: From June 2017 through May 2018, EMR-based HIV and HCV screenings were implemented in three emergency department-affiliated urgent care settings: a local urgent care walk-in clinic; a university-based student health services center; and an urgent care setting located within a multi-specialty clinic. EMR best practice alerts (BPA) were developed based on Centers for Disease Control and Prevention (CDC) guidelines and populated on registered patients who qualified to receive HIV and/or HCV testing. Patients were excluded from the study if they chose to opt out from testing or the provider deemed it clinically inappropriate. Upon notification of a positive HIV and/or HCV test result through the EMR, patient navigators (PNs) were responsible for linking patients to their first medical appointment. Results: From June 2017 through May 2018, 48,531 patients presented to the three urgent care clinics. Out of 27,230 eligible patients, 1,972 patients (7.2%) agreed to be screened for HIV; for HCV, out of 6,509 eligible patients, 1,895 (29.1%) agreed to be screened. Thirty-one patients (1.6%) screened antibody-positive for HCV, with three being ribonucleic acid confirmed positives. No patients in either setting were confirmed positive for HIV; however, two initially screened HIV- positive. PNs were able to link 17 HCV antibody-positive patients (55%) to their first appointment, with the remainder having a scheduled future appointment. Conclusion: Introducing an EMR-based screening program is an effective method to identify and screen eligible patients for HIV and HCV in Appalachian urgent care settings where universal screenings are not routinely implemented. [West J Emerg Med. 2018;19(6)1057–1064.

Comment on Vortex Mass and Quantum Tunneling of Vortices

Vortex mass in Fermi superfluids and superconductors and its influence on quantum tunneling of vortices are discussed. The vortex mass is essentially enhanced due to the fermion zero modes in the core of the vortex: the bound states of the Bogoliubov qiasiparticles localized in the core. These bound states form the normal component which is nonzero even in the low temperature limit. In the collisionless regime $\omega_0\tau \gg 1$, the normal component trapped by the vortex is unbound from the normal component in the bulk superfluid/superconductors and adds to the inertial mass of the moving vortex. In the d-wave superconductors, the vortex mass has an additional factor $(B_{c2}/B)^{1/2}$ due to the gap nodes.Comment: 10 pages, no figures, version accepted in JETP Letter

Can social media reduce discrimination and ignorance towards patients with long term conditions? A chronic kidney disease example in the UK and more widely

Long Term Conditions (LTCs) are increasing in prevalence and cost in Western healthcare. Patients with such conditions are often classed as “disabled”, because of impacts of self-care on “activities of daily life” or secondary consequences of conditions (impairments) affecting factors such as mobility, concentration and communications. Disability needs are often ignored in the design of services and treatment of individuals. It manifests as services which some find difficult to use and lack of personal respect (discrimination) often based on lack of understanding by the healthcare profession itself (ignorance). This paper explores how Social Media (SM), an example “Assistive Technology” in an increasingly digital age, might help. The focus is Chronic Kidney Disease with two, specific illustrations in the UK beginning to spread worldwide. Support mechanisms now emerging may go well beyond healthcare, and even beyond kidney problems. They may also find additional assistance via the new, English Accessible Information Standard.This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text via the publisher's site.Published (Open Access

Ice-lens formation and geometrical supercooling in soils and other colloidal materials

We present a new, physically-intuitive model of ice-lens formation and growth during the freezing of soils and other dense, particulate suspensions. Motivated by experimental evidence, we consider the growth of an ice-filled crack in a freezing soil. At low temperatures, ice in the crack exerts large pressures on the crack walls that will eventually cause the crack to split open. We show that the crack will then propagate across the soil to form a new lens. The process is controlled by two factors: the cohesion of the soil, and the geometrical supercooling of the water in the soil; a new concept introduced to measure the energy available to form a new ice lens. When the supercooling exceeds a critical amount (proportional to the cohesive strength of the soil) a new ice lens forms. This condition for ice-lens formation and growth does not appeal to any ad hoc, empirical assumptions, and explains how periodic ice lenses can form with or without the presence of a frozen fringe. The proposed mechanism is in good agreement with experiments, in particular explaining ice-lens pattern formation, and surges in heave rate associated with the growth of new lenses. Importantly for systems with no frozen fringe, ice-lens formation and frost heave can be predicted given only the unfrozen properties of the soil. We use our theory to estimate ice-lens growth temperatures obtaining quantitative agreement with the limited experimental data that is currently available. Finally we suggest experiments that might be performed in order to verify this theory in more detail. The theory is generalizable to complex natural-soil scenarios, and should therefore be useful in the prediction of macroscopic frost heave rates.Comment: Submitted to PR

A Cepheid Distance to NGC 4603 in Centaurus

In an attempt to use Cepheid variables to determine the distance to the Centaurus cluster, we have obtained images of NGC 4603 with the Hubble Space Telescope on 9 epochs using WFPC2 and the F555W and F814W filters. This galaxy has been suggested to lie within the ``Cen30'' portion of the cluster and is the most distant object for which this method has been attempted. Previous distance estimates for Cen30 have varied significantly and some have presented disagreements with the peculiar velocity predicted from redshift surveys, motivating this investigation. Using our observations, we have found 61 candidate Cepheid variable stars; however, a significant fraction of these candidates are likely to be nonvariable stars whose magnitude measurement errors happen to fit a Cepheid light curve of significant amplitude for some choice of period and phase. Through a maximum likelihood technique, we determine that we have observed 43 +/- 7 real Cepheids and that NGC 4603 has a distance modulus of 32.61 +0.11/-0.10 (random, 1 sigma) +0.24/-0.25 (systematic, adding in quadrature), corresponding to a distance of 33.3 Mpc. This is consistent with a number of recent estimates of the distance to NGC 4603 or Cen30 and implies a small peculiar velocity consistent with predictions from the IRAS 1.2 Jy redshift survey if the galaxy lies in the foreground of the cluster.Comment: Accepted for publication in the Astrophysical Journal. 17 pages with 17 embedded figures and 3 tables using emulateapj.sty. Additional figures and images may be obtained from http://astro.berkeley.edu/~marc/n4603

Generalised Israel Junction Conditions for a Gauss-Bonnet Brane World

In spacetimes of dimension greater than four it is natural to consider higher order (in R) corrections to the Einstein equations. In this letter generalized Israel junction conditions for a membrane in such a theory are derived. This is achieved by generalising the Gibbons-Hawking boundary term. The junction conditions are applied to simple brane world models, and are compared to the many contradictory results in the literature.Comment: 4 page

Towards understanding resprouting at the global scale

Understanding and predicting plant response to disturbance is of paramount importance in our changing world. Resprouting ability is often considered a simple qualitative trait and used in many ecological studies. Our aim is to show some of the complexities of resprouting while highlighting cautions that need be taken in using resprouting ability to predict vegetation responses across disturbance types and biomes. There are marked differences in resprouting depending on the disturbance type, and fire is often the most severe disturbance because it includes both defoliation and lethal temperatures. In the Mediterranean biome, there are differences in functional strategies to cope with water deficit between resprouters (dehydration avoiders) and nonresprouters (dehydration tolerators); however, there is little research to unambiguously extrapolate these results to other biomes. Furthermore, predictions of vegetation responses to changes in disturbance regimes require consideration not only of resprouting, but also other relevant traits (e.g. seeding, bark thickness) and the different correlations among traits observed in different biomes; models lacking these details would behave poorly at the global scale. Overall, the lessons learned from a given disturbance regime and biome (e.g. crown-fire Mediterranean ecosystems) can guide research in other ecosystems but should not be extrapolated at the global scale.This work was performed under the framework of the TREVOL projects (CGL2012-39938-C02-01 to J.G.P.) from the Spanish Government. A.L.J., R.B.P., A.V. and S.P. were supported by the following grants: IOS-1252232 (NSF), IOS-0845125 (NSF), CGL-2011-30531-CO2-02 (SURVIVE Project, Spain), ID-1120458 (Fondo Nacional de Desarrollo Científico y Tecnológico, FONDECYT, Chile), respectively

Early and efficient detection of Mycobacterium tuberculosis in sputum by microscopic observation of broth cultures.

Early, efficient and inexpensive methods for the detection of pulmonary tuberculosis are urgently needed for effective patient management as well as to interrupt transmission. These methods to detect M. tuberculosis in a timely and affordable way are not yet widely available in resource-limited settings. In a developing-country setting, we prospectively evaluated two methods for culturing and detecting M. tuberculosis in sputum. Sputum samples were cultured in liquid assay (micro broth culture) in microplate wells and growth was detected by microscopic observation, or in Löwenstein-Jensen (LJ) solid media where growth was detected by visual inspection for colonies. Sputum samples were collected from 321 tuberculosis (TB) suspects attending Bugando Medical Centre, in Mwanza, Tanzania, and were cultured in parallel. Pulmonary tuberculosis cases were diagnosed using the American Thoracic Society diagnostic standards. There were a total of 200 (62.3%) pulmonary tuberculosis cases. Liquid assay with microscopic detection detected a significantly higher proportion of cases than LJ solid culture: 89.0% (95% confidence interval [CI], 84.7% to 93.3%) versus 77.0% (95% CI, 71.2% to 82.8%) (p = 0.0007). The median turn around time to diagnose tuberculosis was significantly shorter for micro broth culture than for the LJ solid culture, 9 days (interquartile range [IQR] 7-13), versus 21 days (IQR 14-28) (p<0.0001). The cost for micro broth culture (labor inclusive) in our study was US $4.56 per sample, versus US$11.35 per sample for the LJ solid culture. The liquid assay (micro broth culture) is an early, feasible, and inexpensive method for detection of pulmonary tuberculosis in resource limited settings