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Guideline-based tobacco treatment is infrequently offered. Electronic health record-enabled patient-generated health data (PGHD) has the potential to increase patient treatment engagement and satisfaction.
Methods:
We evaluated outcomes of a strategy to enable PGHD in a medical oncology clinic from July 1, 2021 to December 31, 2022. Among 12,777 patients, 82.1% received a tobacco screener about use and interest in treatment as part of eCheck-in via the patient portal.
Results:
We attained a broad reach (82.1%) and moderate response rate (30.9%) for this low-burden PGHD strategy. Patients reporting current smoking (n = 240) expressed interest in smoking cessation medication (47.9%) and counseling (35.8%). As a result of patient requests via PGHD, most tobacco treatment requests by patients were addressed by their providers (40.6–80.3%). Among patients with active smoking, those who received/answered the screener (n = 309 ) were more likely to receive tobacco treatment compared with usual care patients who did not have the patient portal (n = 323) (OR = 2.72, 95% CI = 1.93–3.82, P < 0.0001) using propensity scores to adjust for the effect of age, sex, race, insurance, and comorbidity. Patients who received yet ignored the screener (n = 1024) compared with usual care were also more likely to receive tobacco treatment, but to a lesser extent (OR = 2.20, 95% CI = 1.68–2.86, P < 0.0001). We mapped observed and potential benefits to the Translational Science Benefits Model (TSBM).
Discussion:
PGHD via patient portal appears to be a feasible, acceptable, scalable, and cost-effective approach to promote patient-centered care and tobacco treatment in cancer patients. Importantly, the PGHD approach serves as a real world example of cancer prevention leveraging the TSBM.
The Magellanic Stream (MS), a tail of diffuse gas formed from tidal and ram pressure interactions between the Small and Large Magellanic Clouds (SMC and LMC) and the Halo of the Milky Way, is primarily composed of neutral atomic hydrogen (HI). The deficiency of dust and the diffuse nature of the present gas make molecular formation rare and difficult, but if present, could lead to regions potentially suitable for star formation, thereby allowing us to probe conditions of star formation similar to those at high redshifts. We search for $\text{HCO}^{+}$, HCN, HNC, and C$_2$H using the highest sensitivity observations of molecular absorption data from the Atacama Large Millimeter Array (ALMA) to trace these regions, comparing with HI archival data from the Galactic Arecibo L-Band Feed Array (GALFA) HI Survey and the Galactic All Sky Survey (GASS) to compare these environments in the MS to the HI column density threshold for molecular formation in the Milky Way. We also compare the line of sight locations with confirmed locations of stars, molecular hydrogen, and OI detections, though at higher sensitivities than the observations presented here.
We find no detections to a 3$\sigma$ significance, despite four sightlines having column densities surpassing the threshold for molecular formation in the diffuse regions of the Milky Way. Here we present our calculations for the upper limits of the column densities of each of these molecular absorption lines, ranging from $3 \times 10^{10}$ to $1 \times 10^{13}$ cm$^{-2}$. The non-detection of $\text{HCO}^{+}$ suggests that at least one of the following is true: (i) $X_{\text{HCO}^{+}{}, \mathrm{MS}}$ is significantly lower than the Milky Way value; (ii) that the widespread diffuse molecular gas observed by Rybarczyk (2022b, ApJ, 928, 79) in the Milky Way’s diffuse interstellar medium (ISM) does not have a direct analogue in the MS; (iii) the HI-to-$\text{H}_{2}$ transition occurs in the MS at a higher surface density in the MS than in the LMC or SMC; or (iv) molecular gas exists in the MS, but only in small, dense clumps.
Parents report that around 20% of infants cry a lot without apparent reason during the first four postnatal months. This crying can trigger parental depression, breastfeeding cessation, overfeeding, impaired parent–child relationships and child development, and infant abuse. The Surviving Crying (SC) cognitive behaviour therapy (CBT)-based materials were developed in earlier research to improve the coping, wellbeing and mental health of parents who judge their infant to be crying excessively.
Aim:
This study set out to:
develop a health visitor (HV) training module based on the SC materials, tailored to fit health visiting;
assess whether HVs could deliver a SC-based service successfully;
confirm whether parents gained similar benefits to those in the earlier study;
prepare for a controlled trial of the SC-based service.
Methods:
A training module was developed to enable HVs to deliver the SC materials, much of it provided online. Ten HVs took the training module (‘SC HVs’). They and the Institute of Health Visiting provided feedback to refine it. SC HV delivery of the CBT sessions to parents with excessively crying babies was assessed using a standardised test. Parental wellbeing was measured using validated questionnaires. Parents and SC HVs evaluated the effectiveness of the SC service using questionnaires or interviews.
Findings:
The study produced the intended training module. Most SC HVs completed the training, and 50% delivered the SC-based service successfully. Both training and delivery were disrupted by the Covid-19 pandemic, illness and work pressures. Replicating earlier findings: most parents’ anxiety and depression scores declined substantially after receiving the SC service; improvements in parents’ confidence, frustration and sleep were found; and all parents and the SC HVs interviewed found the SC service useful and agreed it should be included in the National Health Service. A controlled trial of the resulting SC service is underway.
To explore communities’ perspectives on the factors in the social food environment that influence dietary behaviours in African cities.
Design:
A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary behaviours. Follow-up in-depth interviews allowed participants to tell the ‘stories’ of their photographs. Thematic analysis was conducted, using data-driven and theory-driven (based on the socio-ecological model) approaches.
Setting:
Three low-income areas of Nairobi (n 48) in Kenya and Accra (n 62) and Ho (n 32) in Ghana.
Participants:
Adolescents and adults, male and female aged ≥13 years.
Results:
The ‘people’ who were most commonly reported as influencers of dietary behaviours within the social food environment included family members, friends, health workers and food vendors. They mainly influenced food purchase, preparation and consumption, through (1) considerations for family members’ food preferences, (2) considerations for family members’ health and nutrition needs, (3) social support by family and friends, (4) provision of nutritional advice and modelling food behaviour by parents and health professionals, (5) food vendors’ services and social qualities.
Conclusions:
The family presents an opportunity for promoting healthy dietary behaviours among family members. Peer groups could be harnessed to promote healthy dietary behaviours among adolescents and youth. Empowering food vendors to provide healthier and safer food options could enhance healthier food sourcing, purchasing and consumption in African low-income urban communities.
Land divisions are ubiquitous features of the British countryside. Field boundaries, enclosures, pit alignments, and other forms of land division have been used to shape and delineate the landscape over thousands of years. While these divisions are critical for understanding economies and subsistence, the organization of tenure and property, social structure and identity, and their histories of use have remained unclear. Here, the authors present the first robust, Bayesian statistical chronology for land division over three millennia within a study region in England. Their innovative approach to investigating long-term change demonstrates the unexpected scale of later ‘prehistoric’ land demarcation, which may correspond to the beginnings of increasing social hierarchy.
Mental health issues in children and young people are a growing concern and the benefits of intervening early are well established for many mental health problems, but existing Child and Adolescent Mental Health Services (CAMHS) are often over-stretched with variable waiting times for assessment. Many children also have problems which do not reach the referral thresholds and parents are left to find advice elsewhere. Existing resources for parents are scattered across many different websites and therefore difficult to access both for parents and professionals working with young people. With this in mind, and in consultation with CAMHS Bristol and many other stake-holders (including parents themselves) we designed an easily navigable website intended as a single comprehensive portal of resources for parents of children with mental illness and difficulties.
Method
Qualitative research methods were used to gather information about how the website should be designed and also to gather feedback once the website was live. Focus groups were performed with parents/carers and stakeholder discussions took place to inform the design of the website. Once the website was live, surveys via a Survey Monkey link on the website and Google Analytics were used to evaluate the website.
Result
60,000 users have utilised the website since the launch in March 2019. Two thirds of users are women and one third are men. Most popular webpages that are visited are primary, secondary, help-in -a-crisis and self-help for young people. Positive feedback has been collected from both parents/carers and service providers. The website has continued to develop and is now a registered charity and has received community lottery funding, which will allow for further evaluation and developments.
Conclusion
HappyMaps has been successful in providing a single hub of information for parents/carers, GPs, CAMHS workers and teachers. Future work involves evaluating the website and attracting interest from other CAMHS teams and professionals in other areas of the UK so that they can create HappyMaps sections for their populations.
In this paper, we describe the system design and capabilities of the Australian Square Kilometre Array Pathfinder (ASKAP) radio telescope at the conclusion of its construction project and commencement of science operations. ASKAP is one of the first radio telescopes to deploy phased array feed (PAF) technology on a large scale, giving it an instantaneous field of view that covers $31\,\textrm{deg}^{2}$ at $800\,\textrm{MHz}$. As a two-dimensional array of 36$\times$12 m antennas, with baselines ranging from 22 m to 6 km, ASKAP also has excellent snapshot imaging capability and 10 arcsec resolution. This, combined with 288 MHz of instantaneous bandwidth and a unique third axis of rotation on each antenna, gives ASKAP the capability to create high dynamic range images of large sky areas very quickly. It is an excellent telescope for surveys between 700 and $1800\,\textrm{MHz}$ and is expected to facilitate great advances in our understanding of galaxy formation, cosmology, and radio transients while opening new parameter space for discovery of the unknown.
Despite advances in endovascular interventions, including the introduction of drug-eluting stents (DES), high target lesion revascularization (TLR) rates still burden the treatment of symptomatic lower-limb peripheral arterial disease (PAD). EluviaTM, a novel, sustained-release, paclitaxel-eluting DES, was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX® stent, in the IMPERIAL randomized controlled trial. This evaluation estimated the cost-effectiveness of Eluvia when compared with Zilver PTX in Australia, based on 12-month clinical outcomes from the IMPERIAL trial.
Methods
A state-transition, decision-analytic model with a 12-month time horizon was developed from an Australian public healthcare system perspective. Cost parameters were obtained from the Australian National Hospital Cost Data Collection Cost Report (2016–17). All costs were captured in Australian dollars (AUD), where AUD 1 = USD 0.69 (June 2020). Complete sets of clinical parameters (primary patency loss, TLR, amputation, and death) and cost parameters from their respective distributions were bootstrapped in samples of 1,000 patients, for each intervention arm of the model. One-way and probabilistic sensitivity analyses were performed.
Results
At 12 months, modeled TLR rates were 4.5 percent for Eluvia and 8.9 percent for Zilver PTX, and mean total direct costs were AUD 6,537 [USD 4,511] and AUD 6,908 [USD 4,767], respectively (Eluvia average per patient savings; overall cohort=AUD 371 [USD 256]; diabetic cohort=AUD 625 [USD 431]). In probabilistic sensitivity analyses, Eluvia was cost-effective relative to Zilver PTX in 92.0 percent of all simulations at a threshold of $10,000 per TLR avoided. Eluvia was more effective and less costly (dominant) than Zilver PTX in 76.0 percent of simulations.
Conclusions
In the first year after the intervention, Eluvia was more effective and less costly than Zilver PTX, making Eluvia the dominant treatment strategy for treatment of symptomatic lower-limb PAD, from an Australian public healthcare system perspective. These findings should be considered when formulating policy and practice guidelines in the context of priority setting and making evidence-based resource allocation decisions for treatment of PAD in Australia.
We examine whether options exchanges’ pricing schedules affect broker order routing behavior and limit order execution quality. We find that some brokers seemingly maximize the value of their order flow by selling marketable orders and sending nonmarketable orders to exchanges that offer large liquidity rebates. Other brokers appear to bypass liquidity rebates by routing both marketable and nonmarketable orders to exchanges that purchase order flow. Using a decision by the Philadelphia Stock Exchange (PHLX) to change its trading protocol, we provide empirical evidence that brokers can enhance limit order execution quality by routing nonmarketable limit orders to options exchanges that purchase order flow.
SNP in the vitamin D receptor (VDR) gene is associated with risk of lower respiratory infections. The influence of genetic variation in the vitamin D pathway resulting in susceptibility to upper respiratory infections (URI) has not been investigated. We evaluated the influence of thirty-three SNP in eleven vitamin D pathway genes (DBP, DHCR7, RXRA, CYP2R1, CYP27B1, CYP24A1, CYP3A4, CYP27A1, LRP2, CUBN and VDR) resulting in URI risk in 725 adults in London, UK, using an additive model with adjustment for potential confounders and correction for multiple comparisons. Significant associations in this cohort were investigated in a validation cohort of 737 children in Manchester, UK. In all, three SNP in VDR (rs4334089, rs11568820 and rs7970314) and one SNP in CYP3A4 (rs2740574) were associated with risk of URI in the discovery cohort after adjusting for potential confounders and correcting for multiple comparisons (adjusted incidence rate ratio per additional minor allele ≥1·15, Pfor trend ≤0·030). This association was replicated for rs4334089 in the validation cohort (Pfor trend=0·048) but not for rs11568820, rs7970314 or rs2740574. Carriage of the minor allele of the rs4334089 SNP in VDR was associated with increased susceptibility to URI in children and adult cohorts in the United Kingdom.
Method of levels (MOL) is an innovative transdiagnostic cognitive therapy with potential advantages over existing psychological treatments for psychosis.
Aims
The Next Level study is a feasibility randomised controlled trial (RCT) of MOL for people experiencing first-episode psychosis. It aims to determine the suitability of MOL for further testing in a definitive trial (trial registration ISRCTN13359355).
Method
The study uses a parallel group non-masked feasibilityRCT design with two conditions: (a) treatment as usual (TAU) and (b) TAU plus MOL. Participants (n = 36) were recruited from early intervention in psychosis services. Outcome measures are completed at baseline, 10 and 14 months. The primary outcomes are recruitment and retention.
Results
Participants’ demographic and clinical characteristics are presented along with baseline data.
Conclusions
Next Level has recruited to target, providing evidence that it is feasible to recruit to a RCT of MOL for first-episode psychosis.
Guy of Warwick is England's other Arthur. Elevated to the status of national hero, his legend occupied a central place in the nation's cultural heritage from the Middle Ages to the modern period. Guy of Warwick: Icon and Ancestor spans the Guy tradition from its beginnings in Anglo-Norman and Middle English romance right through to the plays and prints of the early modern period and Spenser's Faerie Queene, including the visual tradition in manuscript illustration and material culture as well as the intersection of the legend with local and national history. This volume addresses important questions regarding the continuities and remaking of romance material, and the relation between life and literature. Topics discussed are sensitive to current critical concerns and include translation, reception, magnate ambition, East-West relations, the construction of "Englishness" and national identity, and the literary value of "popular" romance.
ALISON WIGGINS is Lecturer in English Language at the University of Glasgow; ROSALIND FIELD is Reader in Medieval Literature at Royal Holloway, University of London.
CONTRIBUTORS: JUDITH WEISS, MARIANNE AILES, IVANA DJORDJEVIC, ROSALIND FIELD, ALISON WIGGINS, A.S.G. EDWARDS, ROBERT ALLEN ROUSE, DAVID GRIFFITH, MARTHA W. DRIVER, SIAN ECHARD, ANDREW KING, HELEN COOPER
Research on weed management in furrow-irrigated rice is needed as water availability becomes more limited in rice production regions of Arkansas. Research was conducted at Keiser and Pine Tree, AR, with the objectives being to determine (1) whether the addition of clomazone to imazethapyr would improve PRE weed control in furrow-irrigated, imidazolinone-tolerant rice, and (2) whether increasing the imazethapyr rates would improve weed control without injuring rice. Imazethapyr was applied at 70, 87.5, and 105 g ai/ha PRE with and without clomazone followed by imazethapyr POST at the same rate as used PRE. No rice injury was observed during the growing season at either site. Clomazone plus imazethapyr applied PRE did not improve early season control of Palmer amaranth, pitted morningglory, prickly sida, barnyardgrass, or broadleaf signalgrass over imazethapyr alone. Increasing the PRE imazethapyr rate to 105 g/ha did not improve Palmer amaranth or pitted morningglory control. Imazethapyr applied PRE on a clay soil generally provided lower weed control than on the silt loam soil. Increasing the imazethapyr rate did not improve rice yields.
Failure of glyphosate to control Palmer amaranth was first reported in Arkansas in Mississippi County in June, 2005. The objectives of this research were to (a) confirm glyphosate-resistant Palmer amaranth in Arkansas, and (b) determine the effectiveness of 15 postemergence- (POST) applied herbicides comprising eight modes of action in controlling the glyphosate-resistant biotype compared to glyphosate-susceptible accessions. The LD50 values were similar among three susceptible Palmer amaranth accessions, ranging from 24.4 to 35.5 g ae/ha glyphosate. The resistant biotype had an LD50 of 2,820 g/ha glyphosate, which was 79- to 115-fold greater than that of the susceptible biotypes and 3.4 times a normal glyphosate-use rate of 840 g/ha. The glyphosate-resistant biotype was effectively controlled with most of the evaluated herbicides, but the use of acetolactate synthase-inhibiting herbicides such as pyrithiobac, trifloxysulfuron, and imazethapyr is not a viable option for control of this Palmer amaranth population.
Research was conducted in 2007 and 2008 to evaluate weed-control options in an imazethapyr-resistant rice production system. Raised beds were formed, and imidazolinone-resistant hybrid rice ‘CL 730’ was drill-seeded on beds. Five herbicide programs applied up to the four- to six-leaf stage of rice were evaluated with and without additional “as-needed” herbicide at later stages. All the herbicide combinations and as-needed herbicides tested in this research were labeled for rice, and only minor transient injury (< 5%) was initially observed. Weeds emerged throughout the growing season, and as-needed herbicides were applied after the four- to six-leaf stage of rice to control these late-emerging weeds and weeds not effectively controlled with earlier applications, primarily Palmer amaranth. Most of the Palmer amaranth at this site was insensitive to imazethapyr (possibly acetolactate synthase resistant). Therefore, application of as-needed herbicides with different modes of action, such as 2,4-D, were used to improve Palmer amaranth control. Rice yields were often numerically higher in plots that received additional herbicide after the six-leaf stage of rice, but yields were not significantly improved.
The d-dimensional Λ-Fleming-Viot generator acting on functions g(x), with x being a vector of d allele frequencies, can be written as a Wright-Fisher generator acting on functions g with a modified random linear argument of x induced by partitioning occurring in the Λ-Fleming-Viot process. The eigenvalues and right polynomial eigenvectors are easy to see from this representation. The two-dimensional process, which has a one-dimensional generator, is considered in detail. A nonlinear equation is found for the Green's function. In a model with genic selection a proof is given that there is a critical selection value such that if the selection coefficient is greater than or equal to the critical value then fixation, when the boundary 1 is hit, has probability 1 beginning from any nonzero frequency. This is an analytic proof different from the proofs of Der, Epstein and Plotkin (2011) and Foucart (2013). An application in the infinitely-many-alleles Λ-Fleming-Viot process is finding an interesting identity for the frequency spectrum of alleles that is based on size biasing. The moment dual process in the Fleming-Viot process is the usual Λ-coalescent tree back in time. The Wright-Fisher representation using a different set of polynomials gn(x) as test functions produces a dual death process which has a similarity to the Kingman coalescent and decreases by units of one. The eigenvalues of the process are analogous to the Jacobi polynomials when expressed in terms of gn(x), playing the role of xn. Under the stationary distribution when there is mutation, is analogous to the nth moment in a beta distribution. There is a d-dimensional version gn(X), and even an intriguing Ewens' sampling formula analogy when d → ∞.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.