An exploration of the help-seeking experiences of men and women referred to a rapid access chest pain clinic (a cardiac physiologist-managed clinic)

Background Coronary Heart Disease (CHD) is one of the leading causes of death in both men and women worldwide. It is well documented that early diagnosis and treatment of CHD is associated with better outcomes. This has led to the establishment of targets to ensure prompt access to services for potential CHD (e.g. Rapid Access Chest Pain Clinics). Research has shown that these public health targets have caused decreases in morbidity and mortality rates for CHD in the UK. However, despite these improvements health services are still limited by help-seeking practices of patients as they can only act once a patient has presented for treatment. A number of studies have explored the reasons why patients delay help-seeking for CHD symptoms in an emergency context (i.e. having a heart attack). Many studies have focused on gender and have often suggested that women with emergency CHD symptoms delay help-seeking, although this is controversial. Other studies have suggested help-seeking delay is influenced by multiple intersecting factors (e.g. age, ethnicity and contextual influences) and not just gender. No studies have examined help-seeking for suspected CHD symptoms in the context of accessing Rapid Access Chest Pain Clinics (RACPC). Given the lack of understanding in this area, an explorative qualitative study was undertaken to answer the research question: what are the help-seeking experiences of men and women referred to a rapid access chest pain clinic? Methods A total of 30 men and women with a range of ages and ethnicities referred to a RACPC for the investigation of their symptoms were enrolled in this study. Participants took part in semi-structured interviews that focused on attribution of symptoms and how that, amongst other things, influenced help-seeking decisions for their symptoms. The data was analysed thematically to explore men’s and women’s experiences and the help-seeking decisions they made. The study findings and relevant literature were used to inform the development of a patient information leaflet to assist with recognition of potential CHD symptoms and to promote help-seeking. Results The study found, in general, that: attribution of symptoms was linked to contextual factors; reluctance to seek help and response to symptoms contributed to delay; the influence of others acted as enablers of help-seeking; and barriers were linked to accessibility of GP services and time off work. Additionally, some participants had mixed reactions to a negative diagnosis at the end of RACPC assessment (i.e. symptoms not of CHD origin). Some participants expressed frustration at not having an answer for their symptoms, whereas others said they felt like a ‘fraud’ for wasting NHS resources. Not all participants had negative reactions and many were delighted that their symptoms were not heart-related. When it came to perceptions of risk of CHD, most believed the ‘male lifestyle’ was more risky and therefore increased CHD risks in men, but that increasingly women were living ‘male-like lifestyles’ (e.g. working full time, smoking, drinking and eating a poor diet), thus increasing their risk of CHD. Conclusion This novel study based in the RACPC context has produced important findings in this previously unexplored area. Earlier qualitative research based in the emergency CHD context has highlighted the challenges around symptom attribution, attitudes to help-seeking and response to symptoms, and how these factors contribute to delay. This current study showed that there were many similarities between the two different contexts (emergency and non-emergency). These findings can be used to produce health promotion literature to encourage early help-seeking for non-emergency CHD in the RACPC context in both men and women. The output of the current research makes a contribution to practice in my profession through the development of a lay patient resource to promote help-seeking in the RACPC context

Silver stain for electron microscopy

Ammoniacal silver stain used for light microscopy was adapted advantageously for use with very thin biological sections required for electron microscopy. Silver stain can be performed in short time, has more contrast, and is especially useful for low power electron microscopy

Evaporative Deposition in Receding Drops

We present a framework for calculating the surface density profile of a stain deposited by a drop with a receding contact line. Unlike a pinned drop, a receding drop pushes fluid towards its interior, continuously deposits mass across its substrate as it evaporates, and does not produce the usual "coffee ring." For a thin, circular drop with a constant evaporation rate, we find the surface density of the stain goes as $\eta(r) \propto \left(\left(r/a_0\right)^{-1/2}-r/a_0\right)$, where $r$ is the radius from the drop center and $a_0$ is the initial outer radius. Under these conditions, the deposited stain has a mountain-like morphology. Our framework can easily be extended to investigate new stain morphologies left by drying drops.Comment: 6 pages, 4 figure

Green fluorescent diamidines as diagnostic probes for trypanosomes

LED fluorescence microscopy offers potential benefits to the diagnosis of human African trypanosomiasis, as well as to other aspects of diseases management, such as detection of drug resistant strains. To advance such approaches reliable and specific fluorescent markers to stain parasites in human fluids are needed. Here we report a series of novel green fluorescent diamidines and their suitability as probes to stain trypanosomes

Particle motion and stain removal during simulated abrasive tooth cleaning

Stain removal from teeth is important both to prevent decay and for appearance. This is usually achieved using a filament-based toothbrush with a toothpaste consisting of abrasive particles in a carrier fluid. This work has been carried out to examine how these abrasive particles interact with the filaments and cause material removal from a stain layer on the surface of a tooth. It is important to understand this mechanism as while maximum cleaning efficiency is required, this must not be accompanied by damage to the enamel or dentine substrate. In this work simple abrasive scratch tests were used to investigate stain removal mechanism of two abrasive particles commonly used in tooth cleaning, silica and perlite. Silica particles are granular in shape and very different to perlite particles, which are flat and have thicknesses many times smaller than their width. Initially visualisation studies were carried out with perlite particles to study how they are entrained into a filament/counterface contact. Results were compared with previous studies using silica. Reciprocating scratch tests were then run to study how many filaments have a particle trapped at one moment and are involved in the cleaning process. Stain removal tests were then carried out in a similar manner to establish cleaning rates with the two particle types. Perlite particles were found to be less abrasive than silica. This was because of their shape and how they were entrained into the filament contacts and loaded against a counterface. With both particles subsurface damage during stain removal was found to be minimal. A simple model was built to predict stain removal rates with silica particles, which gave results that correlated well with the experimental data

Quantifying the effects of data augmentation and stain color normalization in convolutional neural networks for computational pathology

Stain variation is a phenomenon observed when distinct pathology laboratories stain tissue slides that exhibit similar but not identical color appearance. Due to this color shift between laboratories, convolutional neural networks (CNNs) trained with images from one lab often underperform on unseen images from the other lab. Several techniques have been proposed to reduce the generalization error, mainly grouped into two categories: stain color augmentation and stain color normalization. The former simulates a wide variety of realistic stain variations during training, producing stain-invariant CNNs. The latter aims to match training and test color distributions in order to reduce stain variation. For the first time, we compared some of these techniques and quantified their effect on CNN classification performance using a heterogeneous dataset of hematoxylin and eosin histopathology images from 4 organs and 9 pathology laboratories. Additionally, we propose a novel unsupervised method to perform stain color normalization using a neural network. Based on our experimental results, we provide practical guidelines on how to use stain color augmentation and stain color normalization in future computational pathology applications.Comment: Accepted in the Medical Image Analysis journa

SOX10 commonly stains scar in Mohs sections

Sox10 immunostaining is used for the diagnosis and margin evaluation of melanocytic lesions. Sox10 was initially thought not to stain fibrohistiocytic processes. Consequently, it was believed to reliably distinguish desmoplastic melanoma from scar. However, recent data from formalin sections suggest Sox10 is less specific than previously thought. In this report, we demonstrate that Sox10-stained Mohs sections commonly show strong, fractional staining of scar. When using Sox10 with frozen section immunohistochemistry, Mohs practitioners should recognize the potential of this marker to stain scar to avoid overdiagnosis of desmoplastic melanoma