Publications by authors named "Rebecca Fisher"

130 Publications

Quantification of methane emissions from UK biogas plants.

Waste Manag 2021 Feb 17;124:82-93. Epub 2021 Feb 17.

Department of Earth Sciences, Royal Holloway, University of London, Egham TW20 0EX, United Kingdom.

The rising number of operational biogas plants in the UK brings a new emissions category to consider for methane monitoring, quantification and reduction. Minimising methane losses from biogas plants to the atmosphere is critical not only because of their contribution of methane to global warming but also with respect to the sustainability of renewable energy production. Mobile greenhouse gas surveys were conducted to detect plumes of methane emissions from the biogas plants in southern England that varied in their size, waste feed input materials and biogas utilization. Gaussian plume modelling was used to estimate total emissions of methane from ten biogas plants based on repeat passes through the plumes. Methane emission rates ranged from 0.1 to 58.7 kg CH hr, and the percentage of losses relative to the calculated production rate varied between 0.02 and 8.1%. The average emission rate was 15.9 kg CH hr, and the average loss was 3.7%. In general, methane emission rates from smaller farm biogas plants were higher than from larger food waste biogas plants. We also suggest that biogas methane emissions may account for between 0.4 and 3.8%, with an average being 1.9% of the total methane emissions in the UK excluding the sewage sludge biogas plants.
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http://dx.doi.org/10.1016/j.wasman.2021.01.011DOI Listing
February 2021

Heterogeneous Hydrogel Structures with Spatiotemporal Reconfigurability using Addressable and Tunable Voxels.

Adv Mater 2021 Jan 25:e2005906. Epub 2021 Jan 25.

The Polytechnic School, Fulton Schools of Engineering, Arizona State University, Mesa, AZ, 85212, USA.

Stimuli-responsive hydrogels can sense environmental cues and change their volume accordingly without the need for additional sensors or actuators. This enables a significant reduction in the size and complexity of resulting devices. However, since the responsive volume change of hydrogels is typically uniform, their robotic applications requiring localized and time-varying deformations have been challenging to realize. Here, using addressable and tunable hydrogel building blocks-referred to as soft voxel actuators (SVAs)-heterogeneous hydrogel structures with programmable spatiotemporal deformations are presented. SVAs are produced using a mixed-solvent photopolymerization method, utilizing a fast reaction speed and the cononsolvency property of poly(N-isopropylacrylamide) (PNIPAAm) to produce highly interconnected hydrogel pore structures, resulting in tunable swelling ratio, swelling rate, and Young's modulus in a simple, one-step casting process that is compatible with mass production of SVA units. By designing the location and swelling properties of each voxel and by activating embedded Joule heaters in the voxels, spatiotemporal deformations are achieved, which enables heterogeneous hydrogel structures to manipulate objects, avoid obstacles, generate traveling waves, and morph to different shapes. Together, these innovations pave the way toward tunable, untethered, and high-degree-of-freedom hydrogel robots that can adapt and respond to changing conditions in unstructured environments.
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http://dx.doi.org/10.1002/adma.202005906DOI Listing
January 2021

Effect of stroke early supported discharge on length of hospital stay: analysis from a national stroke registry.

BMJ Open 2021 Jan 20;11(1):e043480. Epub 2021 Jan 20.

Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK.

Objective: The first observational study to investigate the impact of early supported discharge (ESD) on length of hospital stay in real-world conditions.

Design: Using historical prospective Sentinel Stroke National Audit Programme (SSNAP) data (1 January 2013-31 December 2016) and multilevel modelling, cross-sectional (2015-2016; 30 791 patients nested within 55 hospitals) and repeated cross-sectional (2013-2014 vs 2015-2016; 49 266 patients nested within 41 hospitals) analyses were undertaken.

Setting: Hospitals were sampled across a large geographical area of England covering the West and East Midlands, the East of England and the North of England.

Participants: Stroke patients whose data were entered into the SSNAP database by hospital teams.

Interventions: Receiving ESD along the patient care pathway.

Primary And Secondary Outcome Measures: Length of hospital stay.

Results: When adjusted for important case-mix variables, patients who received ESD on their stroke care pathway spent longer in hospital, compared with those who did not receive ESD. The percentage increase was 15.8% (95% CI 12.3% to 19.4%) for the 2015-2016 cross-sectional analysis and 18.8% (95% CI 13.9% to 24.0%) for the 2013-2014 versus 2015-2016 repeated cross-sectional analysis. On average, the increased length of hospital stay was approximately 1 day.

Conclusions: This study has shown that by comparing ESD and non-ESD patient groups matched for important patient characteristics, receiving ESD resulted in a 1-day increase in length of hospital stay. The large reduction in length of hospital stay overall, since original trials were conducted, may explain why a reduction was not observed. The longer term benefits of accessing ESD need to be investigated further.

Trial Registration Number: http://www.isrctn.com/ISRCTN15568163.
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http://dx.doi.org/10.1136/bmjopen-2020-043480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818805PMC
January 2021

Primary care consultation length by deprivation and multimorbidity in England: an observational study using electronic patient records.

Br J Gen Pract 2021 25;71(704):e185-e192. Epub 2021 Feb 25.

The Health Foundation, London.

Background: Longer GP consultations are recommended as one way of improving care for people with multimorbidity. In Scotland, patients who are multimorbid and living in deprived areas do not have longer consultations, although their counterparts in the least deprived areas do. This example of the inverse care law has not been examined in England.

Aim: To assess GP consultation length by socioeconomic deprivation and multimorbidity.

Design And Setting: Random sample of 1.2 million consultations from 1 April 2014 to 31 March 2016 for 190 036 adults in England drawn from the Clinical Practice Research Datalink.

Method: Consultation duration was derived from time of opening and closing the patient's electronic record. Mean duration was estimated by multimorbidity level and type, adjusted for number of consultations and other patient and staff characteristics and patient and practice random effects.

Results: Consultations lasted 10.9 minutes on average and mean duration increased with number of conditions. Patients with ≥6 conditions had 0.9 (95% confidence interval [CI] = 0.8 to 1.0) minutes longer than those with none. Patients who are multimorbid and with a mental health condition had 0.5 (CI = 0.4 to 0.5) minutes longer than patients who were not multimorbid. However, consultations were 0.5 (CI = 0.4 to 0.5) minutes shorter in the most compared with the least deprived fifth of areas at all levels of multimorbidity.

Conclusion: GPs in England spend longer with patients who have more conditions, but, at all multimorbidity levels, those in deprived areas have less time per GP consultation. Further research is needed to assess the impact of consultation length on patient and system outcomes for those with multimorbidity.
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http://dx.doi.org/10.3399/bjgp20X714029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744040PMC
February 2021

Anatomical and histological analyses reveal that tail repair is coupled with regrowth in wild-caught, juvenile American alligators (Alligator mississippiensis).

Sci Rep 2020 11 18;10(1):20122. Epub 2020 Nov 18.

School of Life Sciences, Arizona State University, P.O. Box 874501, Tempe, AZ, 85287, USA.

Reptiles are the only amniotes that maintain the capacity to regenerate appendages. This study presents the first anatomical and histological evidence of tail repair with regrowth in an archosaur, the American alligator. The regrown alligator tails constituted approximately 6-18% of the total body length and were morphologically distinct from original tail segments. Gross dissection, radiographs, and magnetic resonance imaging revealed that caudal vertebrae were replaced by a ventrally-positioned, unsegmented endoskeleton. This contrasts with lepidosaurs, where the regenerated tail is radially organized around a central endoskeleton. Furthermore, the regrown alligator tail lacked skeletal muscle and instead consisted of fibrous connective tissue composed of type I and type III collagen fibers. The overproduction of connective tissue shares features with mammalian wound healing or fibrosis. The lack of skeletal muscle contrasts with lizards, but shares similarities with regenerated tails in the tuatara and regenerated limbs in Xenopus adult frogs, which have a cartilaginous endoskeleton surrounded by connective tissue, but lack skeletal muscle. Overall, this study of wild-caught, juvenile American alligator tails identifies a distinct pattern of wound repair in mammals while exhibiting features in common with regeneration in lepidosaurs and amphibia.
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http://dx.doi.org/10.1038/s41598-020-77052-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674433PMC
November 2020

Utility of Abnormal Head Computed Tomography in Predicting Outcome in Out-of-Hospital Cardiac Arrest Victims.

Ther Hypothermia Temp Manag 2020 Oct 6. Epub 2020 Oct 6.

Department of Emergency Medicine, Beaumont Health System, Royal Oak, Michigan, USA.

Head computed tomography (HCT) is often performed postcardiac arrest to assess for hypoxic-ischemic brain injury. Our primary objective was to assess whether cerebral edema (CE) on early HCT is associated with poor survival and neurologic outcome after out-of-hospital cardiac arrest (OHCA).We included subjects from a prospectively collected database of OHCA adults who received targeted temperature management at two hospitals from July 2009 to July 2018. We included cases if an emergency department (ED) HCT was performed. Patient demographics and cardiac arrest variables were collected. HCT results were abstracted from radiology reports. HCT findings were categorized as no acute disease, evidence of CE, or excluded (bleed, tumor, and stroke). Outcomes were survival to discharge or dichotomized discharge cerebral performance category (CPC) of 1-2 (good neurologic outcome) versus 3-5 (poor neurologic outcome). Univariate and multivariate analyses were performed. There were 425 OHCA, of which 315 had ED HCT with 277 cases included. Patients were predominately male (65.0%), average age of 60.9 years and average body mass index of 30.5. Of all cases, 44 (15.9%) showed CE on computed tomography. Univariate analysis demonstrated that CE was associated with 9.2-fold greater odds of poor outcome (odds ratio [OR]: 9.23; 95% confidence interval [CI] 1.73-49.2) and 9.1-fold greater odds of death (OR: 9.09, 95% CI 2.4-33.9). In adjusted analysis, CE was associated with a poor CPC outcome (adjusted odds ratios [AOR]: 14.9, 95% CI 2.49-88.4), and death (AOR: 13.7, 95% CI 3.26-57.4). Adjusted survival analysis demonstrated that patients with CE on HCT had 3.6-fold greater hazard of death than those without CE (hazard ratios 3.56, 95% CI 2.34-5.41). The results identify that CE on HCTs early in the postarrest period in OHCA patients is strongly associated with poor rates of survival and neurologic outcome. Prospective work is needed to further define the role of early HCT in postarrest neuroprognostication.
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http://dx.doi.org/10.1089/ther.2020.0026DOI Listing
October 2020

Methane flux from flowback operations at a shale gas site.

J Air Waste Manag Assoc 2020 12 27;70(12):1324-1339. Epub 2020 Oct 27.

British Geological Survey, Environmental Science Centre , Nottingham, UK.

We report measurements of methane (CH) mixing ratios and emission fluxes derived from sampling at a monitoring station at an exploratory shale gas extraction facility in Lancashire, England. Elevated ambient CH mixing ratios were recorded in January 2019 during a period of cold-venting associated with a nitrogen lift process at the facility. These processes are used to clear the well to stimulate flow of natural gas from the target shale. Estimates of CH flux during the emission event were made using three independent modeling approaches: Gaussian plume dispersion (following both a simple Gaussian plume inversion and the US EPA OTM 33-A method), and a Lagrangian stochastic transport model (WindTrax). The three methods yielded an estimated peak CH flux during January 2019 of approximately 70 g s. The total mass of CH emitted during the six-day venting period was calculated to be 2.9, 4.2 ± 1.4(1σ) and 7.1 ± 2.1(1σ) tonnes CH using the simple Gaussian plume model, WindTrax, and OTM-33A methods, respectively. Whilst the flux approaches all agreed within 1σ uncertainty, an estimate of 4.2 (± 1.4) tonnes CH represents the most confident assessment due to the explicit modeling of advection and meteorological stability permitted using the WindTrax model. This mass is consistent with fluxes calculated by the Environment Agency (in the range 2.7 to 6.8 tonnes CH), using emission data provided by the shale site operator to the regulator. This study provides the first CH emission estimate for a nitrogen lift process and the first-reported flux monitoring of a UK shale gas site, and contributes to the evaluation of the environmental impacts of shale gas operations worldwide. This study also provides forward guidance on future monitoring applications and flux calculation in transient emission events. : This manuscript discusses atmospheric measurements near to the UK's first hydraulic fracturing facility, which has very high UK public, media, and policy interest. The focus of this manuscript is on a single week of data in which a large venting event at the shale gas site saw emissions of ~4 tonnes of methane to atmosphere, in breach of environmental permits. These results are likely to beresults are likely to be reported by the media and may influence future policy decisions concerning the UK hydraulic fracturing industry.
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http://dx.doi.org/10.1080/10962247.2020.1811800DOI Listing
December 2020

Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States.

Authors:
Rachel M Burke Sharon Balter Emily Barnes Vaughn Barry Karri Bartlett Karlyn D Beer Isaac Benowitz Holly M Biggs Hollianne Bruce Jonathan Bryant-Genevier Jordan Cates Kevin Chatham-Stephens Nora Chea Howard Chiou Demian Christiansen Victoria T Chu Shauna Clark Sara H Cody Max Cohen Erin E Conners Vishal Dasari Patrick Dawson Traci DeSalvo Matthew Donahue Alissa Dratch Lindsey Duca Jeffrey Duchin Jonathan W Dyal Leora R Feldstein Marty Fenstersheib Marc Fischer Rebecca Fisher Chelsea Foo Brandi Freeman-Ponder Alicia M Fry Jessica Gant Romesh Gautom Isaac Ghinai Prabhu Gounder Cheri T Grigg Jeffrey Gunzenhauser Aron J Hall George S Han Thomas Haupt Michelle Holshue Jennifer Hunter Mireille B Ibrahim Max W Jacobs M Claire Jarashow Kiran Joshi Talar Kamali Vance Kawakami Moon Kim Hannah L Kirking Amanda Kita-Yarbro Rachel Klos Miwako Kobayashi Anna Kocharian Misty Lang Jennifer Layden Eva Leidman Scott Lindquist Stephen Lindstrom Ruth Link-Gelles Mariel Marlow Claire P Mattison Nancy McClung Tristan D McPherson Lynn Mello Claire M Midgley Shannon Novosad Megan T Patel Kristen Pettrone Satish K Pillai Ian W Pray Heather E Reese Heather Rhodes Susan Robinson Melissa Rolfes Janell Routh Rachel Rubin Sarah L Rudman Denny Russell Sarah Scott Varun Shetty Sarah E Smith-Jeffcoat Elizabeth A Soda Christopher Spitters Bryan Stierman Rebecca Sunenshine Dawn Terashita Elizabeth Traub Grace M Vahey Jennifer R Verani Megan Wallace Matthew Westercamp Jonathan Wortham Amy Xie Anna Yousaf Matthew Zahn

PLoS One 2020 2;15(9):e0238342. Epub 2020 Sep 2.

The COVID-19 Close Contact Investigation Team, United States of America.

Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238342PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467265PMC
September 2020

The Challenge of COVID-19: The Biological Characteristics and Outcomes in a Series of 130 Breast Cancer Patients Operated on During the Pandemic.

Chirurgia (Bucur) 2020 Jul-Aug;115(4):458-468

The worldwide outbreak of the 2019 novel coronavirus disease (COVID-19) emerged in Wuhan, China close to the end of 2019. We analyse the clinical characteristics and management outcomes of a small group of patients who have been treated in the early stage of the COVID-19 disease, and discuss the impact of the pandemic on the service delivered to breast cancer patients. Material We analysed a cohort of 130 breast cancer patients who underwent elective surgical procedures during the early period of COVID-19. The patients were operated on in the period from March 16th, 2020 to May 18th, 2020. All the patients were female, with an age range of 33-88 years, with a median age of 57.6 years. Most of the cases were admitted as a day case surgery after passing through a preoperative screening pathway, which was developed gradually. Patients were contacted by phone after their surgery to ensure that they have had no symptoms and were reviewed in person two weeks after the procedure with histology results. Only one patient developed COVID-19 symptoms after surgery and recovered. Early and careful implementation of modified practice policies during emerging situation of viral pandemics will reduce the risk of perioperative complications, reduce the risk of patient to staff to patient transmission and minimize the negative impact of COVID-19 on breast cancer management.
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http://dx.doi.org/10.21614/chirurgia.115.4.458DOI Listing
September 2020

Effectiveness of Stroke Early Supported Discharge: Analysis From a National Stroke Registry.

Circ Cardiovasc Qual Outcomes 2020 Aug 17;13(8):e006395. Epub 2020 Jul 17.

University of Nottingham, United Kingdom (R.J.F., A.B., N.C., S.L., M.F.W.).

Background: Implementation of stroke early supported discharge (ESD) services has been recommended in many countries' clinical guidelines, based on clinical trial evidence. This is the first observational study to investigate the effectiveness of ESD service models operating in real-world conditions, at scale.

Methods And Results: Using historical prospective data from the United Kingdom Sentinel Stroke National Audit Programme (January 1, 2016-December 31, 2016), measures of ESD effectiveness were "days to ESD" (number of days from hospital discharge to first ESD contact; n=6222), "rehabilitation intensity" (total number of treatment days/total days with ESD; n=5891), and stroke survivor outcome (modified Rankin scale at ESD discharge; n=6222). ESD service models (derived from Sentinel Stroke National Audit Programme postacute organizational audit data) were categorized with a 17-item score, reflecting adoption of ESD consensus core components (evidence-based criteria). Multilevel modeling analysis was undertaken as patients were clustered within ESD teams across the Midlands, East, and North of England (n=31). A variety of ESD service models had been adopted, as reflected by variability in the ESD consensus score. Controlling for patient characteristics and Sentinel Stroke National Audit Programme hospital score, a 1-unit increase in ESD consensus score was significantly associated with a more responsive ESD service (reduced odds of patient being seen after ≥1 day of 29% [95% CI, 1%-49%] and increased treatment intensity by 2% [95% CI, 0.3%-4%]). There was no association with stroke survivor outcome measured by the modified Rankin Scale.

Conclusions: This study has shown that adopting defined core components of ESD is associated with providing a more responsive and intensive ESD service. This shows that adherence to evidence-based criteria is likely to result in a more effective ESD service as defined by process measures. Registration: URL: http://www.isrctn.com/; Unique identifier: ISRCTN15568163.
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http://dx.doi.org/10.1161/CIRCOUTCOMES.119.006395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439934PMC
August 2020

Effects of malleable kinetochore morphology on measurements of intrakinetochore tension.

Open Biol 2020 07 8;10(7):200101. Epub 2020 Jul 8.

New York State Department of Health, Wadsworth Center, Albany, NY, USA.

The distance between fluorescent spots formed by various kinetochore proteins (delta) is commonly interpreted as a manifestation of intrakinetochore tension (IKT) caused by microtubule-mediated forces. However, large-scale changes of the kinetochore architecture (such as its shape or dimensions) may also contribute to the value of delta. To assess contributions of these non-elastic changes, we compare behaviour of delta values in human kinetochores with small yet mechanically malleable kinetochores against compound kinetochores in Indian muntjac (IM) cells whose architecture remains constant. Due to the micrometre-scale length of kinetochore plates in IM, their shape and orientation are discernible in conventional light microscopy, which enables precise measurements of IKT independent of contributions from changes in overall architecture of the organelle. We find that delta in IM kinetochores remains relatively constant when microtubule-mediated forces are suppressed by Taxol, but it prominently decreases upon detachment of microtubules. By contrast, large decreases of delta observed in Taxol-treated human cells coincide with prominent changes in length and curvature of the kinetochore plate. These observations, supported by computational modelling, suggest that at least 50% of the decrease in delta in human cells reflects malleable reorganization of kinetochore architecture rather than elastic recoil due to IKT.
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http://dx.doi.org/10.1098/rsob.200101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571466PMC
July 2020

Assessment of Technical Skills in Axillary Lymph Node Dissection.

Ann Surg 2020 Jun 24. Epub 2020 Jun 24.

Department of Surgery and Cancer, Imperial College London, London, UK.

Objective: A simulator to enable safe practice and assessment of ALND has been designed, and face, content and construct validity has been investigated.

Summary And Background Data: The reduction in the number of ALNDs conducted has led to decreased resident exposure and confidence.

Methods: A cross-sectional multicenter observational study was carried out between July 2017 and August 2018. Following model development, 30 surgeons of varying experience (n = "experts,' n = 11 "senior residents,' and n = 10 "junior residents") were asked to perform a simulated ALND. Face and content validity questionnaires were administered immediately after ALND. All ALND procedures were retrospectively assessed by 2 attending breast surgeons, blinded to operator identity, using a video-based assessment tool, and an end product assessment tool.

Results: Statistically significant differences between groups were observed across all operative subphases on the axillary clearance assessment tool (P < 0.001). Significant differences between groups were observed for overall procedure quality (P < 0.05) and total number of lymph nodes harvested (P < 0.001). However, operator grade could not be distinguished across other end product variables such as axillary vein damage (P = 0.864) and long thoracic nerve injury (P = 0.094). Overall, participants indicated that the simulator has good anatomical (median score >7) and procedural realism (median score >7).

Conclusions: Video-based analysis demonstrates construct validity for ALND assessment. Given reduced ALND exposure, this simulation is a useful adjunct for both technical skills training and formative Deanery or Faculty administered assessments.
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http://dx.doi.org/10.1097/SLA.0000000000003946DOI Listing
June 2020

Biopsychosocial intervention for stroke carers (BISC): results of a feasibility randomised controlled trial and nested qualitative interview study.

Clin Rehabil 2020 Oct 21;34(10):1268-1281. Epub 2020 Jun 21.

Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle-Upon-Tyne, UK.

Objective: To determine the feasibility of recruiting to and delivering a biopsychosocial intervention for carers of stroke survivors.

Design: Feasibility randomised controlled study with nested qualitative interview study.

Setting: The intervention was delivered in the community in either a group or one-to-one format.

Subjects: Carers and stroke survivors within one year of stroke onset.

Interventions: A carer targeted intervention delivered by a research psychologist in six structured two-hour sessions or usual care control. The intervention combined education about the biological, psychological and social effects of stroke with strategies and techniques focussing on adjustment to stroke and caregiving. Stroke survivors in both groups received baseline and follow-up assessment but no intervention.

Main Outcome: Recruitment rate, study attrition, fidelity of intervention delivery, acceptability and sensitivity of outcome measures used (health related quality of life, anxiety and depression and carer burden six months after randomisation).

Results: Of the 257 carers approached, 41 consented. Six withdrew before randomisation. Eighteen participants were randomised to receive the intervention and 17 to usual care. Attendance at sessions was greater when treated one-to-one. Feedback interviews suggested that participants found the intervention acceptable and peer support particularly helpful in normalising their feelings. Thirty participants were assessed at follow-up with improvements from baseline on all health measures for both groups.

Conclusions: Our results suggest that a biopsychosocial intervention was acceptable to carers and can be delivered in group and one-to-one formats. Timing of approach and mode of intervention delivery is critical and requires tailoring to the carers individual needs.
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http://dx.doi.org/10.1177/0269215520937039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469713PMC
October 2020

Early recovery dynamics of turbid coral reefs after recurring bleaching events.

J Environ Manage 2020 Aug 14;268:110666. Epub 2020 May 14.

CSIRO Oceans & Atmosphere, Indian Ocean Marine Research Centre, Perth, WA, 6009, Australia.

The worlds' coral reefs are declining due to the combined effects of natural disturbances and anthropogenic pressures including thermal coral bleaching associated with global climate change. Nearshore corals are receiving increased anthropogenic stress from coastal development and nutrient run-off. Considering forecast increases in global temperatures, greater understanding of drivers of recovery on nearshore coral reefs following widespread bleaching events is required to inform management of local stressors. The west Pilbara coral reefs, with cross-shelf turbidity gradients coupled with a large nearby dredging program and recent history of repeated coral bleaching due to heat stress, represent an opportune location to study recovery from multiple disturbances. Mean coral cover at west Pilbara reefs was monitored from 2009 to 2018 and declined from 45% in 2009 to 5% in 2014 following three heat waves. Recruitment and juvenile abundance of corals were monitored from 2014 to 2018 and were combined with biological and physical data to identify which variables enhanced or hindered early-stage coral recovery of all hard corals and separately for the acroporids, the genera principally responsible for recovery in the short-term (<7 years). From 2014 to 2018, coral cover increased from 5 to 10% but recovery varied widely among sites (0-13%). Hard coral cover typically recovered most at shallower sites that had higher abundance of herbivorous fish, less macroalgae, and lower turbidity. Similarly, acroporid corals recovered most at sites with lower turbidity and macroalgal cover. Juvenile acroporid densities were a good indicator of recovery at least two years after they were recorded. However, recruitment to settlement tiles was not a good predictor of total coral or acroporid recovery. This study shows that coral recovery can be slower in areas of high turbidity and the rate may be reduced by local pressures, such as dredging. Management should focus on improving or maintaining local water quality to increase the likelihood of coral recovery under climate stress. Further, in turbid environments, juvenile coral density predicts early coral recovery better than recruits on tiles and may be a more cost-effective technique for monitoring recovery potential.
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http://dx.doi.org/10.1016/j.jenvman.2020.110666DOI Listing
August 2020

Toxicity of ten herbicides to the tropical marine microalgae Rhodomonas salina.

Sci Rep 2020 05 6;10(1):7612. Epub 2020 May 6.

Australian Institute of Marine Science, Townsville, QLD 4810, Australia.

Herbicide contamination of nearshore tropical marine ecosystems is widespread and persistent; however, risks posed by most 'alternative' herbicides to tropical marine microalgae remain poorly understood. Experimental exposures of the important but understudied microalgae Rhodomonas salina to seven individual Photosystem II (PSII) inhibitor herbicides (diuron, metribuzin, hexazinone, tebuthiuron, bromacil, simazine, propazine) led to inhibition of effective quantum yield (ΔF/F') and subsequent reductions in specific growth rates (SGR). The concentrations which reduced ΔF/F' by 50% (EC) ranged from 1.71-59.2 µg L, while the ECs for SGR were 4-times higher, ranging from 6.27-188 µg L. Inhibition of ΔF/F' indicated reduced photosynthetic capacity, and this correlated linearly with reduced SGR (R = 0.89), supporting the application of ∆F/F' inhibition as a robust and sensitive indicator of sub-lethal toxicity of PSII inhibitors for this microalga. The three non-PSII inhibitor herbicides (imazapic, haloxyfop and 2,4-Dichlorophenoxyacetic acid (2,4-D)) caused low or no toxic responses to the function of the PSII or growth at the highest concentrations tested suggesting these herbicides pose little risk to R. salina. This study highlights the suitability of including R. salina in future species sensitivity distributions (SSDs) to support water quality guideline development for the management of herbicide contamination in tropical marine ecosystems.
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http://dx.doi.org/10.1038/s41598-020-64116-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203118PMC
May 2020

Responses of corals to chronic turbidity.

Sci Rep 2020 03 16;10(1):4762. Epub 2020 Mar 16.

Australian Institute of Marine Science (AIMS), Townsville, QLD and Perth, WA, Australia.

Dredging increases suspended sediment concentrations (SSCs), causing elevated water turbidity (cloudiness) and light attenuation. Close to dredging, low light periods can extend over many days, affecting phototrophic epibenthic organisms like corals. To improve the ability to predict and manage dredging impacts, we tested the response of corals to an extended period of elevated turbidity using an automated sediment dosing system that precisely controlled SSCs and adjusted light availability accordingly. Replicates of four common species of corals encompassing different morphologies were exposed to turbidity treatments of 0-100 mg L SSC, corresponding to daily light integrals of 12.6 to 0 mol quanta m d, over a period of ∼7 weeks. Symbiotic dinoflagellate density and algal pigment concentration, photosynthetic yields, lipid concentrations and ratios and growth varied among the turbidity treatments, with corals exhibiting photoacclimation within low turbidity treatments. A range of physiological responses were observed within the high turbidity treatments (low light), including bleaching and changes in lipid levels and ratios. Most corals, except P. damicornis, were capable of adjusting to a turbidity treatment involving a mean light level of 2.3 mol photons m d in conjunction with a SSC of 10 mg L over the 7 week period.
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http://dx.doi.org/10.1038/s41598-020-61712-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075922PMC
March 2020

Provision of Contraception in New York City School-Based Health Centers: Impact on Teenage Pregnancy and Avoided Costs, 2008-2017.

Perspect Sex Reprod Health 2019 12;51(4):201-209

The Office of School Health, New York City Department of Health and Mental Hygiene, New York.

Context: Since 2008, the School-Based Health Center Reproductive Health Project (SBHC RHP) has supported SBHCs in New York City (NYC) to increase the availability of effective contraception; however, its impact on teenage pregnancy and avoided costs has not been estimated.

Methods: The impact of the SBHC RHP on patterns of contraceptive use and on the numbers of pregnancies, abortions and births averted in 2008-2017 was estimated using program data and public data from the NYC Bureau of Vital Statistics and Youth Risk Behavior Survey. Data from the Guttmacher Institute on the cost of publicly funded births and abortions were used to estimate costs avoided; NYC-specific teenage pregnancy outcome data were employed to estimate the proportion of overall declines attributable to the SBHC RHP.

Results: Between 2008 and 2017, the SBHC RHP supported a substantial increase in the proportion of sexually active female clients using effective contraceptives. Most dramatically, 14% of clients in the SBHC RHP method mix used LARCs in 2017, compared with 2% in the non-SBHC RHP mix. The project averted an estimated 5,376 pregnancies, 2,104 births and 3,085 abortions, leading to an estimated $30,360,352 in avoided one-time costs of publicly funded births and abortions. These averted events accounted for 26-28% of the decline in teenage pregnancies, births and abortions in NYC.

Conclusions: When comprehensive reproductive health services are available in SBHCs, teenagers use them, resulting in substantially fewer pregnancies, abortions and births, and lower costs to public health systems.
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http://dx.doi.org/10.1363/psrh.12126DOI Listing
December 2019

Noncanonical Wnt as a prognostic marker in prostate cancer: "you can't always get what you Wnt".

Expert Rev Mol Diagn 2020 02 12;20(2):245-254. Epub 2019 Dec 12.

Massachusetts General Hospital Cancer Center and Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

: Wnt signaling is important for normal development, cell proliferation, and cell differentiation. However, aberrations in the pathway can lead to tumorigenesis and cancer progression. Recent genome-wide studies have demonstrated the frequent occurrence of Wnt pathway alterations in prostate cancer. Although alterations in the Wnt pathway in prostate cancer may have an impact on prognosis, recent studies suggest that the Wnt pathway also plays an important role in disease progression and treatment resistance.: We review the literature with regard to the potential prognostic significance of noncanonical Wnt signaling in prostate cancer. After a brief overview of the canonical and noncanonical Wnt pathways, we discuss the preclinical and clinical evidence for activation of Wnt signaling in prostate cancer. We focus on clinical evidence for noncanonical Wnt pathway components to serve as potential prognostic biomarkers.: Although many therapeutic options are available for men with prostate cancer, there remains an unmet need for prognostic and predictive biomarkers to precisely guide clinical management. Early evidence suggests that components of the noncanonical Wnt pathway may serve as prognostic biomarkers. However, prospective validation studies are necessary before these biomarkers can be routinely applied in the clinic.
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http://dx.doi.org/10.1080/14737159.2020.1702522DOI Listing
February 2020

Environmental baseline monitoring for shale gas development in the UK: Identification and geochemical characterisation of local source emissions of methane to atmosphere.

Sci Total Environ 2020 Mar 3;708:134600. Epub 2019 Nov 3.

British Geological Survey, Environmental Science Centre, Keyworth, Nottingham NG12 5GG, UK.

Baseline mobile surveys of methane sources using vehicle-mounted instruments have been performed in the Fylde and Ryedale regions of Northern England over the 2016-19 period around proposed unconventional (shale) gas extraction sites. The aim was to identify and characterise methane sources ahead of hydraulically fractured shale gas extraction in the area around drilling sites. This allows a potential additional source of emissions to atmosphere to be readily distinguished from adjacent sources, should gas production take place. The surveys have used ethane:methane (C2:C1) ratios to separate combustion, thermogenic gas and biogenic sources. Sample collection of source plumes followed by high precision δC analysis of methane, to separate and isotopically characterise sources, adds additional biogenic source distinction between active and closed landfills, and ruminant eructations from manure. The surveys show that both drill sites and adjacent fixed monitoring sites have cow barns and gas network pipeline leaks as sources of methane within a 1 km range. These two sources are readily separated by isotopes (δC of -67 to -58‰ for barns, compared to -43 to -39‰ for gas leaks), and ethane:methane ratios (<0.001 for barns, compared to >0.05 for gas leaks). Under a well-mixed daytime atmospheric boundary layer these sources are generally detectable as above baseline elevations up to 100 m downwind for gas leaks and up to 500 m downwind for populated cow barns. It is considered that careful analysis of these proxies for unconventional production gas, if and when available, will allow any fugitive emissions from operations to be distinguished from surrounding sources.
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http://dx.doi.org/10.1016/j.scitotenv.2019.134600DOI Listing
March 2020

UK's poor performance on cancer survival.

BMJ 2019 10 28;367:l6122. Epub 2019 Oct 28.

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http://dx.doi.org/10.1136/bmj.l6122DOI Listing
October 2019

The implications of high bed occupancy rates on readmission rates in England: A longitudinal study.

Health Policy 2019 08 22;123(8):765-772. Epub 2019 Jun 22.

The Health Foundation, 90 Long Acre, London, WC2E 9RA, United Kingdom.

Hospital bed occupancy rates in the English National Health Service have risen to levels considered clinically unsafe. This study assesses the association of increased bed occupancy with changes in the percentage of overnight patients discharged from hospital on a given day, and their subsequent 30-day readmission rate. Longitudinal panel data methods are used to analyse secondary care records (n = 4,193,590) for 136 non-specialist Trusts between April 2014 and February 2016. The average bed occupancy rate across the study period was 90.4%. A 1% increase in bed occupancy was associated with a 0.49% rise in the discharge rate, and a 0.011% increase in the 30-day readmission rate for discharged patients. These associations became more pronounced once bed occupancy exceeded 95%. When bed occupancy rates were high, hospitals discharged a greater proportion of their patients. Those were mostly younger and less clinically complex, suggesting that hospitals are successfully prioritising early discharge amongst least vulnerable patients. However, while increased bed occupancy was not associated with a substantial increase in overall 30-day readmission rates, the relationship was more pronounced in older and sicker patients, indicating possible links with short-fallings in discharge processes.
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http://dx.doi.org/10.1016/j.healthpol.2019.06.006DOI Listing
August 2019

Axillary lymph node dissection training in a post-Z0011 era: A survey of UK breast surgery trainees.

Breast J 2019 09 25;25(5):1037-1041. Epub 2019 Jun 25.

Department of Surgery and Cancer, Imperial College London, London, UK.

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http://dx.doi.org/10.1111/tbj.13398DOI Listing
September 2019

Sediment deposition and coral smothering.

PLoS One 2019 19;14(6):e0216248. Epub 2019 Jun 19.

Australian Institute of Marine Science (AIMS), Perth, Western Australia, Australia.

Dredging in the marine environment to create and maintain safe, navigable shipping channels, and subsequent disposal of the material at sea in dredge material placement sites (spoil grounds) can generate large quantities of suspended sediment that can impact upon epibenthic marine communities. For sensitive taxa such as hard corals, understanding the mechanisms of mortality and the spatial scale over which these occur is critically important for impact prediction purposes, management of dredging using zonation schemes, and also public perception. We describe the sediment deposition field from suspended sediment falling back out of suspension created around a large (7.6 Mm3) 1.5-year capital dredging project on a reef, using data from 2 weekly repeat observations of >500 individually tagged corals at multiple locations from 0.2-25 km from the dredging. The observations were supported by concurrent in situ measurements of proxy suspended sediment concentrations, underwater light, and sediment deposition (using optical backscatter sensors), and before and after surveys of seabed particle size distributions (PSDs). The distance at which 90% of the effect (from maximum to minimum) had dissipated (ED10) was 20 km away from the dredging for suspended sediment concentrations (estimated via nephelometry), and underwater light (measured using PAR sensors) associated with turbid plumes, 14 km for sediment deposition (measured using optical backscatter sensors) and 4.6 km for changes seabed clay and silt content (PSD analysis). The ED10 for smothering of corals (the build-up of pools of loose sediment on the surface that could not be removed by self-cleaning) occurred much closer still at 3-3.3 km or (0.5-0.6 km for an ED50). Smothering was common on encrusting and foliose forms where sediments accumulated in hollows and massive hemispherical forms where surface undulations (bumps) allowed sediments to pool. Smothering was never observed on branching species, even under extreme levels of sedimentation. Sediment smothering resulted in tissue bleaching and partial mortality (lesion formation), but if sediments were removed (by currents) bleached areas regained pigmentation over weeks and there was regrowth/reparation of lesions over weeks and months even before the dredging was completed. Overall sedimentation tolerance was highly related to coral morphology and surface inclination and the ability to avoid smothering by having uninterrupted downhill pathways for sediment transport across the colony.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216248PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584000PMC
February 2020

What is the impact of large-scale implementation of stroke Early Supported Discharge? A mixed methods realist evaluation study protocol.

Implement Sci 2019 06 13;14(1):61. Epub 2019 Jun 13.

University of Nottingham, Nottingham, UK.

Background: Stroke Early Supported Discharge (ESD) is a service innovation that facilitates discharge from hospital and delivery of specialist rehabilitation in patients' homes. There is currently widespread implementation of ESD services in many countries, driven by robust clinical trial evidence. In England, the type of ESD service patients receive on the ground is variable, and in some regions, ESD is still not offered at all. This protocol presents a study designed to investigate the mechanisms and outcomes of implementing ESD at scale in real-world conditions. This will help to establish which models of ESD are most effective and in what context.

Methods: A realist evaluation approach composed of two interlinking work packages will be adopted to investigate how and why ESD works, for whom and in what circumstances. Work package 1 (WP1) will begin with a rapid evidence synthesis to formulate preliminary realist hypotheses. Quantitative analyses of historical prospective Sentinel Stroke National Audit Programme (SSNAP) data will be performed to evaluate service outcomes based on the degree to which evidence-based ESD has been implemented. Work package 2 (WP2) will involve the qualitative investigation of purposively selected case study sites featuring in WP1 and covering different regions in England. The perspectives of clinicians, managers, commissioners, and service users will be explored qualitatively. Cost implications of ESD models will be examined using a cost-consequence analysis. Cross-case comparisons and triangulation of the data sources from both work packages will be performed to test, revise, and refine initial programme theories and address research aims.

Discussion: This study will investigate whether and how current large-scale implementation of ESD is achieving the outcomes suggested by the evidence base. The theory-driven evaluation approach will highlight key mechanisms and contextual conditions necessary to optimise outcomes and allow us to draw transferable lessons to inform the effective implementation and sustainability of ESD in clinical practice. In addition, the methodological framework will progress the theoretical understanding of implementation and evaluation of complex rehabilitation interventions in stroke care.

Trial Registration: ISRCTN: 15568163, registration date: 26 October 2018.
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http://dx.doi.org/10.1186/s13012-019-0908-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567399PMC
June 2019

A baseline of atmospheric greenhouse gases for prospective UK shale gas sites.

Sci Total Environ 2019 Sep 21;684:1-13. Epub 2019 May 21.

British Geological Survey, Environmental Science Centre, Nicker Hill, Keyworth, Nottingham NG12 5GG, UK.

We report a 24-month statistical baseline climatology for continuously-measured atmospheric carbon dioxide (CO) and methane (CH) mixing ratios linked to surface meteorology as part of a wider environmental baselining project tasked with understanding pre-existing local environmental conditions prior to shale gas exploration in the United Kingdom. The baseline was designed to statistically characterise high-precision measurements of atmospheric composition gathered over two full years (between February 1st 2016 and January 31st 2018) at fixed ground-based measurement stations on, or near to, two UK sites being developed for shale gas exploration involving hydraulic fracturing. The sites, near Blackpool (Lancashire) and Kirby Misperton (North Yorkshire), were the first sites approved in the UK for shale gas exploration since a moratorium was lifted in England. The sites are operated by Cuadrilla Resources Ltd. and Third Energy Ltd., respectively. A statistical climatology of greenhouse gas mixing ratios linked to prevailing local surface meteorology is presented. This study diagnoses and interprets diurnal, day-of-week, and seasonal trends in measured mixing ratios and the contributory role of local, regional and long-range emission sources. The baseline provides a set of contextual statistical quantities against which the incremental impacts of new activities (in this case, future shale gas exploration) can be quantitatively assessed. The dataset may also serve to inform the design of future case studies, as well as direct baseline monitoring design at other potential shale gas and industrial sites. In addition, it provides a quantitative reference for future analyses of the impact, and efficacy, of specific policy interventions or mitigating practices. For example, statistically significant excursions in measured concentrations from this baseline (e.g. >99th percentile) observed during phases of operational extraction may be used to trigger further examination in order to diagnose the source(s) of emission and links to on-site activities at the time, which may be of importance to regulators, site operators and public health stakeholders. A guideline algorithm for identifying these statistically significant excursions, or "baseline deviation events", from the expected baseline conditions is presented and tested. Gaussian plume modelling is used to further these analyses, by simulating approximate upper-limits of CH fluxes which could be expected to give observable enhancements at the monitoring stations under defined meteorological conditions.
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http://dx.doi.org/10.1016/j.scitotenv.2019.05.266DOI Listing
September 2019

Synergistic and antagonistic impacts of suspended sediments and thermal stress on corals.

Nat Commun 2019 05 28;10(1):2346. Epub 2019 May 28.

Australian Institute of Marine Science (MO96), University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.

Understanding pressure pathways and their cumulative impacts is critical for developing effective environmental policy. For coral reefs, wide spread bleaching resulting from global warming is occurring concurrently with local pressures, such as increases in suspended sediments through coastal development. Here we examine the relative importance of suspended sediment pressure pathways for dredging impacts on corals and evidence for synergistic or antagonistic cumulative effects between suspended sediments and thermal stress. We show that low to moderate reductions in available light associated with dredging may lead to weak antagonistic (less than expected independently) cumulative effects. However, when sediment loads are high any reductions in mortality associated with reduced bleaching are outweighed by increased mortality associated with severe low light periods and high levels of sediment deposition and impacts become synergistic (greater than what would occur independently). The findings suggest efforts to assess global cumulative impacts need to consider how pressures interact to impact ecosystems, and that the cumulative outcome may vary across the range of realised pressure fields.
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http://dx.doi.org/10.1038/s41467-019-10288-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538670PMC
May 2019

Out-of-hours primary care end of life prescribing: a data linkage study.

BMJ Support Palliat Care 2020 Dec 9;10(4):e45. Epub 2019 May 9.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

Objectives: Out-of-hours (OOH) primary care services are contacted in the last 4 weeks of life by nearly 30% of all patients who die, but OOH palliative prescribing remains poorly understood. Our understanding of prescribing demand has previously been limited by difficulties identifying palliative patients seen OOH. This study examines the volume and type of prescriptions issued by OOH services at the end of life.

Methods: A retrospective cohort study was performed by linking a database of Oxfordshire OOH service contacts over a year with national mortality data, identifying patients who died within 30 days of OOH contact. Demographic, service and prescribing data were analysed.

Results: A prescription is issued at 14.2% of contacts in the 30 days prior to death, compared with 29.9% of other contacts. The most common prescriptions were antibiotics (22.2%) and strong opioids (19%). 41.8% of prescriptions are for subcutaneously administered medication. Patients who were prescribed a syringe driver medication made twice as many OOH contacts in the 30 days prior to death compared with those who were not.

Conclusion: Absolute and relative prescribing rates are low in the 30 days prior to death. Further research is required to understand what occurs at these non-prescribing end of life contacts to inform how OOH provision can best meet the needs of dying patients. Overall, relatively few patients are prescribed strong opioids or syringe drivers. When a syringe driver medication is prescribed this may help identify patients likely to be in need of further support from the service.
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http://dx.doi.org/10.1136/bmjspcare-2019-001784DOI Listing
December 2020

Three-dimensional architecture of epithelial primary cilia.

Proc Natl Acad Sci U S A 2019 05 19;116(19):9370-9379. Epub 2019 Apr 19.

Wadsworth Center, New York State Department of Health, Albany, NY 12201;

We report a complete 3D structural model of typical epithelial primary cilia based on structural maps of full-length primary cilia obtained by serial section electron tomography. Our data demonstrate the architecture of primary cilia differs extensively from the commonly acknowledged 9+0 paradigm. The axoneme structure is relatively stable but gradually evolves from base to tip with a decreasing number of microtubule complexes (MtCs) and a reducing diameter. The axonemal MtCs are cross-linked by previously unrecognized fibrous protein networks. Such an architecture explains why primary cilia can elastically withstand liquid flow for mechanosensing. The nine axonemal MtCs in a cilium are found to differ significantly in length indicating intraflagellar transport processes in primary cilia may be more complicated than that reported for motile cilia. The 3D maps of microtubule doublet-singlet transitions generally display longitudinal gaps at the inner junction between the A- and B-tubules, which indicates the inner junction protein is a major player in doublet-singlet transitions. In addition, vesicles releasing from kidney primary cilia were observed in the structural maps, supporting that ciliary vesicles budding may serve as ectosomes for cell-cell communication.
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http://dx.doi.org/10.1073/pnas.1821064116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511023PMC
May 2019

Implementation in rehabilitation: a roadmap for practitioners and researchers.

Disabil Rehabil 2020 Nov 12;42(22):3265-3274. Epub 2019 Apr 12.

School of Medicine, University of Nottingham, Nottingham, UK.

Despite growth in rehabilitation research, implementing research findings into rehabilitation practice has been slow. This creates inequities for patients and is an ethical issue. However, methods to investigate and facilitate evidence implementation are being developed. This paper aims to make these methods relevant and accessible for rehabilitation researchers and practitioners. Rehabilitation practice is varied and complex and occurs within multilevel healthcare systems. Using a "road map" analogy, we describe how implementation concepts and theories can inform implementation strategies in rehabilitation. The roadmap involves a staged journey that considers: the nature of evidence; context for implementation; navigation tools for implementation; strategies to facilitate implementation; evaluation of implementation outcomes; and sustainability of implementation. We have developed a model to illustrate the journey, and four case studies exemplify implementation stages in rehabilitation settings. Effective implementation strategies for the complex world of rehabilitation are urgently required. The journey we describe unpacks that complexity to provide a template for effective implementation, to facilitate translation of the growing evidence base in rehabilitation into improved patient outcomes. It emphasizes the importance of understanding context and application of relevant theory, and highlights areas which should be targeted in new implementation research in rehabilitation.Implications for rehabilitationEffective implementation of research evidence into rehabilitation practice has many interconnected steps and a roadmap analogy is helpful in defining them.Understanding context for implementation is critically important and using theory can facilitate development of understanding.Research methods for implementation in rehabilitation should be carefully selected and outcomes should evaluate implementation success as well as clinical change.Sustainability requires regular revisiting of the interconnected steps.
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http://dx.doi.org/10.1080/09638288.2019.1587013DOI Listing
November 2020

Treatment outcomes and associations in an adolescent-specific early intervention for psychosis service.

Early Interv Psychiatry 2019 06 28;13(3):707-714. Epub 2019 Jan 28.

CAMHS, NHS Lothian, Edinburgh, UK.

Aim: Compared with adult onset psychosis, adolescent psychosis has been associated with poorer outcomes in terms of social and cognitive functioning and negative symptoms. Young people experiencing first episode psychosis have developmental needs that frequently pre-date and are compounded by psychosis onset (a previous study). There is a lack of published studies of adolescent onset psychosis and further information is needed so that developmentally appropriate interventions can be developed. We report an observational naturalistic cohort study of an adolescent specific service, the Early Psychosis Support service (EPSS).

Method: We examined baseline demographic and clinical variables, treatments outcomes and predictors of outcome for this population.

Results: The mean age of our sample was 16.3 years. Median duration of untreated illness (DUI) was 88 weeks, and median duration of untreated psychosis (DUP) was 16 weeks. We found significant improvements in positive symptoms, negative symptoms, disorganization, excitement, emotional distress and depression from 0 to 12 months. We found that baseline positive symptoms and DUI significantly predicted positive symptoms at 12 months and only negative symptoms at baseline predicted 12-month negative symptoms.

Conclusion: Our finding that specialist early intervention for adolescents experiencing psychosis is effective suggests that such treatment should be routinely offered in line with existing clinical guidelines. Our finding that DUI is predictive of poorer outcome at 12 months suggests that even earlier intervention from a specialist team may further improve treatment outcomes.
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http://dx.doi.org/10.1111/eip.12778DOI Listing
June 2019