Cyclone: A close air support aircraft for tomorrow

To meet the threat of the battlefield of the future, the U.S. ground forces will require reliable air support. To provide this support, future aircrews demand a versatile close air support aircraft capable of delivering ordinance during the day, night, or in adverse weather with pin-point accuracy. The Cyclone aircraft meets these requirements, packing the 'punch' necessary to clear the way for effective ground operations. Possessing anti-armor, missile, and precision bombing capability, the Cyclone will counter the threat into the 21st Century. Here, it is shown that the Cyclone is a realistic, economical answer to the demand for a capable close air support aircraft

Application of Inelastic Neutron Scattering to the Methanol-to-Gasoline Reaction Over a ZSM-5 Catalyst

Inelastic neutron scattering (INS) is used to investigate a ZSM-5 catalyst that has been exposed to methanol vapour at elevated temperature. In-line mass spectrometric analysis of the catalyst exit stream confirms methanol-to-gasoline chemistry, whilst ex situ INS measurements detect hydrocarbon species formed in/on the catalyst during methanol conversion. These preliminary studies demonstrate the capability of INS to complement infrared spectroscopic characterisation of the hydrocarbon pool present in/on ZSM-5 during the MTG reaction

Role of students' context in predicting academic performance at a medical school: a retrospective cohort study

OBJECTIVES: This study examines associations between medical students’ background characteristics (postcode-based measures of disadvantage, high school attended, sociodemographic characteristics), and academic achievement at a Russell Group University. DESIGN: Retrospective cohort analysis. SETTING: Applicants accepted at the University of Liverpool medical school between 2004 and 2006, finalising their studies between 2010 and 2011. PARTICIPANTS: 571 students (with an English home postcode) registered on the full-time Medicine and Surgery programme, who successfully completed their medical degree. MAIN OUTCOME MEASURES: Final average at year 4 of the medical programme (represented as a percentage). RESULTS: Entry grades were positively associated with final attainment (p<0.001). Students from high-performing schools entered university with higher qualifications than students from low-performing schools (p<0.001), though these differences did not persist at university. Comprehensive school students entered university with higher grades than independent school students (p<0.01), and attained higher averages at university, though differences were not significant after controlling for multiple effects. Associations between school type and achievement differed between sexes. Females attained higher averages than males at university. Significant academic differences were observed between ethnic groups at entry level and university. Neither of the postcode-based measures of disadvantage predicted significant differences in attainment at school or university. CONCLUSIONS: The findings of this study suggest that educational attainment at school is a good, albeit imperfect, predictor of academic attainment at medical school. Most attainment differences observed between students either decreased or disappeared during university. Unlike previous studies, independent school students did not enter university with the highest grades, but achieved the lowest attainment at university. Such variations depict how patterns may differ between subjects and higher-education institutions. Findings advocate for further evidence to help guide the implementation of changes in admissions processes and widen participation at medical schools fairly

Development of a Core Outcome Set for effectiveness trials aimed at optimising prescribing in older adults in care homes

Background: Prescribing medicines for older adults in care homes is known to be sub-optimal. Whilst trials testing interventions to optimise prescribing in this setting have been published, heterogeneity in outcome reporting has hindered comparison of interventions, thus limiting evidence synthesis. The aim of this study was to develop a core outcome set (COS), a list of outcomes which should be measured and reported, as a minimum, for all effectiveness trials involving optimising prescribing in care homes. The COS was developed as part of the Care Homes Independent Pharmacist Prescribing Study (CHIPPS). Methods: A long-list of outcomes was identified through a review of published literature and stakeholder input. Outcomes were reviewed and refined prior to entering a two-round online Delphi exercise and then distributed via a web link to the CHIPPS Management Team, a multidisciplinary team including pharmacists, doctors and Patient Public Involvement representatives (amongst others), who comprised the Delphi panel. The Delphi panellists (n = 19) rated the importance of outcomes on a 9-point Likert scale from 1 (not important) to 9 (critically important). Consensus for an outcome being included in the COS was defined as ≥70% participants scoring 7–9 and <15% scoring 1–3. Exclusion was defined as ≥70% scoring 1–3 and <15% 7–9. Individual and group scores were fed back to participants alongside the second questionnaire round, which included outcomes for which no consensus had been achieved. Results: A long-list of 63 potential outcomes was identified. Refinement of this long-list of outcomes resulted in 29 outcomes, which were included in the Delphi questionnaire (round 1). Following both rounds of the Delphi exercise, 13 outcomes (organised into seven overarching domains: medication appropriateness, adverse drug events, prescribing errors, falls, quality of life, all-cause mortality and admissions to hospital (and associated costs)) met the criteria for inclusion in the final COS. Conclusions: We have developed a COS for effectiveness trials aimed at optimising prescribing in older adults in care homes using robust methodology. Widespread adoption of this COS will facilitate evidence synthesis between trials. Future work should focus on evaluating appropriate tools for these key outcomes to further reduce heterogeneity in outcome measurement in this context

Stanniocalcin 1 effects on the renal gluconeogenesis pathway in rat and fish

The mammalian kidney contributes significantly to glucose homeostasis through gluconeogenesis. Considering that stanniocalcin 1 (STC1) regulates ATP production, is synthesized and acts in different cell types of the nephron, the present study hypothesized that STC1 may be implicated in the regulation of gluconeogenesis in the vertebrate kidney. Human STC1 strongly reduced gluconeogenesis from C-14-glutamine in rat renal medulla (MD) slices but not in renal cortex (CX), nor from C-14-lactic acid. Total PEPCK activity was markedly reduced by hSTC1 in MD but not in CX. Pck2 (mitochondrial PEPCK isoform) was down-regulated by hSTC1 in MD but not in CX. In fish (Dicentrarchus labrax) kidney slices, both STC1-A and -B isoforms decreased gluconeogenesis from C-14-acid lactic, while STC1-A increased gluconeogenesis from C-14-glutamine. Overall, our results demonstrate a role for STC1 in the control of glucose synthesis via renal gluconeogenesis in mammals and suggest that it may have a similar role in teleost fishes. (C) 2015 Elsevier Ireland Ltd. All rights reserved.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) Brazil; Foundation for Science and Technology of Portugal [PTDC/MAR/121279/2010]; bilateral programme CAPES (Brazil)/GRICES (Portugal) CAPES/GRICES [215/08]info:eu-repo/semantics/publishedVersio

Metabolic requirement of septic shock patients before and after liberation from mechanical ventilation

Objectives:Negative energy balance can impair regeneration of the respiratory epithelium and limit the functionality of respiratory muscles, which can prolong mechanical ventilation. The present study sought to quantify and identify the difference in energy expenditure of patients with septic shock during and upon liberation from mechanical ventilation. Methods:Patients admitted into intensive care with initial diagnosis of septic shock and mechanical ventilation-dependent were recruited. Their metabolic requirements before and after liberation from mechanical ventilation were measured by indirect calorimetry. A paired t-test was used to examine the variance between the two modes of breathing and a Spearman rho correlation coefficient to examine relationship of selected indicators.Results: Thirty-five patients, 20 males and 15 females mean age 69 ±10 years, body height of 1.58 ±0.08 meters, and ideal body mass 59.01 ±7.63 kg were recruited. Median APACHEII score was 22, length of stay in the intensive care was 45 ±65 days and duration on mechanical ventilation was 24 ±25 days. Measured energy expenditure during ventilation was 2090 ±489 kcal∙d-1 upon liberation from ventilation was 1910 ±579 kcal∙d-1 and actual caloric intake was 1148 ±495 kcal∙d-1. Measured energy expenditure (p=0.02), actual calories provision and energy expenditure with (p=0.00) and without (p=0.00) ventilator support were all significantly different. Mean carbohydrate oxidation was 0.17 ±0.09 g·min-1 when patients were on mechanical ventilation compared to 0.14 ±0.08 g·min-1 upon liberation, however, this difference was not statistically significant. Furthermore, mean lipid oxidation was 0.08 ±0.05 g·min-1 during mechanical ventilation and 0.09±0.07 g·min-1 upon liberation, which was also not statistically different. Comparison of carbohydrate utilization and lipid oxidation was not different during (0.7±0.36 vs 0.75±0.47 kcal·min-1) and upon liberation from mechanical ventilation (0.55±0.33 vs 0.78±0.59 kcal·min-1).Conclusions: This study examined energy expenditure and substrate oxidation within a single cohort of patients with and without mechanical ventilation. Measured energy expenditure was found to be higher during mechanical ventilation. The possible explanations were positive pressure support from ventilation, the repeated cycle of “rest” and “work” during weaning from ventilators and the asynchronization between self-initiated breathing effort and the ventilatory support. The change energy expenditure with and without ventilatory support should be monitored so that mismatch could be aligned. Future studies are important to examine whether matching energy expenditure with energy intake would promote positive outcomes.<br/

Common variation near CDKN1A, POLD3 and SHROOM2 influences colorectal cancer risk

We performed a meta-analysis of five genome-wide association studies to identify common variants influencing colorectal cancer (CRC) risk comprising 8,682 cases and 9,649 controls. Replication analysis was performed in case-control sets totaling 21,096 cases and 19,555 controls. We identified three new CRC risk loci at 6p21 (rs1321311, near CDKN1A; P = 1.14 × 10(-10)), 11q13.4 (rs3824999, intronic to POLD3; P = 3.65 × 10(-10)) and Xp22.2 (rs5934683, near SHROOM2; P = 7.30 × 10(-10)) This brings the number of independent loci associated with CRC risk to 20 and provides further insight into the genetic architecture of inherited susceptibility to CRC.Swedish Research Council et al.Manuscrip

Innovative Virtual Reality (VR) Application for Preventing of Falls among Chinese Older Adults : A Usability and Acceptance Exploratory Study

Objective: Full immersive virtual reality (VR) technology shows potential for reducing the risks of falls in older adults. There is yet little evidence to support the usability and acceptance on using VR technology application in community aged care service. The study reports on research that aims to address that gap by evaluating the usefulness and acceptance of using an innovative VR application among Chinese older adults from Hong Kong. Methods: A single-arm exploratory study was conducted to evaluate how the participants experienced the use of a fully immersive cave automatic virtual environment (CAVE) VR program on fall prevention. Thirty-one participants were recruited by convenience sampling based on their fall concerns and potential risk of falls. The participants completed 16 training sessions over eight weeks using the VR CAVE application. They were asked to complete a VR usability questionnaire (HK-version) based on the Technology Acceptance Model and previous research, and they took fall risk assessments at the pretest, posttest, and follow-up. Results: The participants’ group significantly showed improvements in reducing the risk factors of falls including balance, functional mobility, walking speed, and fear of falling after VR intervention. Perceived usefulness (PU), perceived enjoyment (PE), user experience (UE), and intention to use (IU) had an overall significant change at different time points. These are important factors to influence the participants’ acceptance of the use of VR technology applications. Perceived ease of use (PEOU) and social norms (SNs) had an inconsistent result, and some items had low validity. The findings indicated a positive training effect on fall prevention and high acceptance of the adoption of the VR technology application. Conclusion: This study supports the growing evidence on the usefulness and acceptance of using full immersive VR training on fall prevention among Chinese older adults. They perceived that the VR CAVE application was useful and innovative as an effective fall prevention training. Technically, the application of VR CAVE technology faces many challenges and is not easily manageable under COVID-19 restrictions and the limitation on technological adaptation for older adults. However, investment in full immersive VR technology application is supported for future adoption in aged care and rehabilitation services

Virtual reality game-based training for preventing falls among community-dwelling older adults with mild cognitive impairment : A pilot randomized control trial study

Using a Virtual Reality (VR) game-based application represents an innovative approach to falls prevention in community aged care service. The study investigated the effects of VR training on falls prevention among community-dwelling older adults with mild cognitive impairment. A pilot randomized controlled trial was conducted to compare the effects of full-immersive VR training with group-based exercise (Baduanjin) training on falls prevention. Eighteen participants were recruited through convenience sampling and were randomly assigned to either the VR group or the non-VR exercise group. Both groups participated in 16 falls prevention training sessions over eight weeks. Participants, identified with mild cognitive impairment (MCI), underwent three fall risk measurements. They had been screened using Montreal Cognitive Assessment (HK-MoCA). The primary outcomes assessed included changes in physical risk factors of falls (i.e. functional mobility, walk speed and postural balance), and the secondary outcomes assessed included changes in executive function and fall efficacy. The measurement of physical outcomes was Time Up and Go test (TUG), Berg balance scale (BBS) and Six-minute Walk Test (6MWT). The participants’ executive function and fear of falling were assessed through the Trail marking test (TMTA and TMTB) and the Fall Efficacy International scale (FES-I). The results showed that the VR group had significantly greater improvement than the non-VR group on measures of cognitive-motor performance, such as global cognition, functional mobility, balance and walk speed over time. However, no significant differences were observed between the two groups in executive functions and the fall efficacy. The study provides potential evidence that VR game-based cognitive-motor training can be effective for fall prevention in community dwelling older adults with MCI. However, the findings do not support significant improvements in secondary outcomes. Despite this, the growing trend of VR research suggests increasing interest and potential for future applications in aged care and rehabilitation services