Latent tuberculosis infection screening and treatment in HIV: insights from evaluation of UK practice

Latent TB infection (LTBI) screening and treatment in HIV-positive individuals in the UK is advocated by the British HIV Association (BHIVA) and National Institute for Health and Care Excellence (NICE), although each recommends differing strategies. We undertook an evaluation of UK practice, relating the responses to the local HIV/TB disease burden. 162 of 188 (86%) UK geographical areas responded; only 93/162 (57.4%) offer LTBI testing with considerable heterogeneity in practice, and no difference in HIV/TB burden between areas offering testing and those who do not. Only 33/93 (35.5%) and 6/93 (6.5%) reported full compliance with BHIVA and NICE guidance respectively. A uniform national guideline is required

Racial and Ethnic Diversity in Grounded Theory Research

National initiatives in the United States call for health research that addresses racial/ethnic disparities. Although grounded theory (GT) research has the potential to contribute much to the understanding of the health experiences of people of color, the extent to which it has contributed to health disparities research is unclear. In this article we describe a project in which we reviewed 44 GT studies published in Qualitative Health Research within the last five years. Using a framework proposed by Green, Creswell, Shope, and Clark (2007), we categorized the studies at one of four levels based on the status and significance afforded racial/ethnic diversity. Our results indicate that racial/ethnic diversity played a primary role in five studies, a complementary role in one study, a peripheral role in five studies, and an absent role in 33 studies. We suggest that GT research could contribute more to health disparities research if techniques were developed to better analyze the influence of race/ethnicity on health-related phenomena

Preoperative localisation for parathyroid surgery in primary hyperparathyroidism: a study to evaluate the clinical utility of different imaging modalities

Primary hyperparathyroidism (PHPT) is caused by a solitary benign adenoma in 80‐85% of cases, but may also be due to multi‐gland or ectopic disease, hyperplasia, and rarely parathyroid carcinoma. Preoperative localisation studies are important to identify patients suitable for minimally invasive parathyroid surgery. The aim of this study was to evaluate the accuracy of ultrasound (US), parathyroid scintigraphy (MIBI) and computed tomography (CT) utilised in the preoperative setting in a district general hospital, with limited access to single photon‐emission computed tomography (SPECT)

Pennsylvanian-Early Triassic stratigraphy in the Alborz Mountains (Iran)

New fieldwork was carried out in the central and eastern Alborz, addressing the sedimentary succession from the Pennsylvanian to the Early Triassic. A regional synthesis is proposed, based on sedimentary analysis and a wide collection of new palaeontological data. The Moscovian Qezelqaleh Formation, deposited in a mixed coastal marine and alluvial setting, is present in a restricted area of the eastern Alborz, transgressing on the Lower Carboniferous Mobarak and Dozdehband formations. The late Gzhelian–early Sakmarian Dorud Group is instead distributed over most of the studied area, being absent only in a narrow belt to the SE. The Dorud Group is typically tripartite, with a terrigenous unit in the lower part (Toyeh Formation), a carbonate intermediate part (Emarat and Ghosnavi formations, the former particularly rich in fusulinids), and a terrigenous upper unit (Shah Zeid Formation), which however seems to be confined to the central Alborz. A major gap in sedimentation occurred before the deposition of the overlying Ruteh Limestone, a thick package of packstone–wackestone interpreted as a carbonate ramp of Middle Permian age (Wordian–Capitanian). The Ruteh Limestone is absent in the eastern part of the range, and everywhere ends with an emersion surface, that may be karstified or covered by a lateritic soil. The Late Permian transgression was directed southwards in the central Alborz, where marine facies (Nesen Formation) are more common. Time-equivalent alluvial fans with marsh intercalations and lateritic soils (Qeshlaq Formation) are present in the east. Towards the end of the Permian most of the Alborz emerged, the marine facies being restricted to a small area on the Caspian side of the central Alborz. There, the Permo-Triassic boundary interval is somewhat similar to the Abadeh–Shahreza belt in central Iran, and contains oolites, flat microbialites and domal stromatolites, forming the base of the Elikah Formation. The P–T boundary is established on the basis of conodonts, small foraminifera and stable isotope data. The development of the lower and middle part of the Elikah Formation, still Early Triassic in age, contains vermicular bioturbated mudstone/wackestone, and anachronostic-facies-like gastropod oolites and flat pebble conglomerates. Three major factors control the sedimentary evolution. The succession is in phase with global sea-level curve in the Moscovian and from the Middle Permian upwards. It is out of phase around the Carboniferous–Permian boundary, when the Dorud Group was deposited during a global lowstand of sealevel. When the global deglaciation started in the Sakmarian, sedimentation stopped in the Alborz and the area emerged. Therefore, there is a consistent geodynamic control. From the Middle Permian upwards, passive margin conditions control the sedimentary evolution of the basin, which had its depocentre(s) to the north. Climate also had a significant role, as the Alborz drifted quickly northwards with other central Iran blocks towards the Turan active margin. It passed from a southern latitude through the aridity belt in the Middle Permian, across the equatorial humid belt in the Late Permian and reached the northern arid tropical belt in the Triassic

Stepwise assembly of an adamantoid Ru4Ag6 cage by control of metal coordination geometry at specific sites

The geometrically pure ‘complex ligand’ fac-[Ru(Lph)3]2+, in which three pendant bidentate binding sites are located on one face of the complex, reacts with Ag(I) ions to form the adamantoid decanuclear cage [{Ru(Lph)3}4Ag6](PF6)14 which contains a 6-coordinate Ru(II) ion at each vertex of a large tetrahedron and a 4-coordinate Ag(I) ion along each edge

Lactate Testing Revisited: A Reliable Indicator of Training Progress for All Swimmers.

We examined the use of lactate testing to monitor training progress in swimming at a small liberal arts college, using an inexpensive handheld lactate analyzer. The tests were carried out by undergraduates as part of their investigative learning curriculum in exercise science. Twelve female athletes participated in a 2-year program of periodic testing using a 5 × 200 swim of increasing intensity. Blood lactate values were measured from a sample obtained 2-4 min after each swim, plotted against swim time, and the maximal lactate steady state (MLSS) was identified. MLSS improved significantly throughout the training period (higher by 0.56 mmol/L and lower by 5.92 s, p \u3c .05), accompanied by significant improvements in swim performance in middle distances. We conclude that the use of a handheld lactate analyzer is an effective method to monitor training progress in swimming. The low cost of the procedure and the participation of undergraduate students were novel applications of established protocols

Early Cenozoic denudation of central west Britain in response to transient and permanent uplift above a mantle plume

Upwelling mantle plumes beneath continental crust are predicted to produce difficult to quantify, modest uplift and denudation. The contribution of permanent and transient components to the uplift is also difficult to distinguish. A pulse of denudation in Britain in the Early Paleogene has been linked, although with some controversy, with the arrival of the proto-Iceland mantle plume. In this contribution we show that combining apatite and zircon (U-Th-Sm)/He and apatite fission track analyses from central west Britain with numerical modeling clearly identifies a pulse of early Cenozoic denudation. The data indicate that rock uplift and denudation were centered on the northern East Irish Sea Basin and 1.0–2.4 km of rocks were removed during the latest Cretaceous-early Paleogene. Uplift and erosion appears to have started a few million years before the earliest magmatism in the region. The regional denudation pattern mirrors the distribution of low-density magmatic rocks that has been imaged in the deep crust. However, the injection of the underplating melt is not enough to account for the total denudation. An additional regional uplift of at least 300 m is required, which is consistent with a transient thermal effect from the hot mantle plume. The rapid exhumation event ceased by ~40 Ma and the data do not require significant Neogene exhumation

Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoples’ experiences

Background Coronary heart disease is an incurable condition. The only approach known to slow its progression is healthy lifestyle change and concordance with cardio-protective medicines. Few people fully succeed in these daily activities so potential health improvements are not fully realised. Little is known about peoples’ experiences of managing lifestyle change. The aim of this study was to synthesise qualitative research to explain how participants make lifestyle change after a cardiac event and explore this within the wider illness experience. Methods A qualitative synthesis was conducted drawing upon the principles of meta-ethnography. Qualitative studies were identified through a systematic search of 7 databases using explicit criteria. Key concepts were identified and translated across studies. Findings were discussed and diagrammed during a series of audiotaped meetings. Results The final synthesis is grounded in findings from 27 studies, with over 500 participants (56% male) across 8 countries. All participants experienced a change in their self-identity from what was ‘familiar’ to ‘unfamiliar’. The transition process involved ‘finding new limits and a life worth living’ , ‘finding support for self’ and ‘finding a new normal’. Analyses of these concepts led to the generation of a third order construct, namely an ongoing process of ‘reassessing past, present and future lives’ as participants considered their changed identity. Participants experienced a strong urge to get back to ‘normal’. Support from family and friends could enable or constrain life change and lifestyle changes. Lifestyle change was but one small part of a wider ‘life’ change that occurred. Conclusions The final synthesis presents an interpretation, not evident in the primary studies, of a person-centred model to explain how lifestyle change is situated within ‘wider’ life changes. The magnitude of individual responses to a changed health status varied. Participants experienced distress as their notion of self identity shifted and emotions that reflected the various stages of the grief process were evident in participants’ accounts. The process of self-managing lifestyle took place through experiential learning; the level of engagement with lifestyle change reflected an individual’s unique view of the balance needed to manage ‘realistic change’ whilst leading to a life that was perceived as ‘worth living’. Findings highlight the importance of providing person centred care that aligns with both psychological and physical dimensions of recovery which are inextricably linked

The HY5-PIF regulatory module coordinates light and temperature control of photosynthetic gene transcription

The ability to interpret daily and seasonal alterations in light and temperature signals is essential for plant survival. This is particularly important during seedling establishment when the phytochrome photoreceptors activate photosynthetic pigment production for photoautotrophic growth. Phytochromes accomplish this partly through the suppression of phytochrome interacting factors (PIFs), negative regulators of chlorophyll and carotenoid biosynthesis. While the bZIP transcription factor long hypocotyl 5 (HY5), a potent PIF antagonist, promotes photosynthetic pigment accumulation in response to light. Here we demonstrate that by directly targeting a common promoter cis-element (G-box), HY5 and PIFs form a dynamic activation-suppression transcriptional module responsive to light and temperature cues. This antagonistic regulatory module provides a simple, direct mechanism through which environmental change can redirect transcriptional control of genes required for photosynthesis and photoprotection. In the regulation of photopigment biosynthesis genes, HY5 and PIFs do not operate alone, but with the circadian clock. However, sudden changes in light or temperature conditions can trigger changes in HY5 and PIFs abundance that adjust the expression of common target genes to optimise photosynthetic performance and growth

Ascertainment of vaccination status by self-report versus source documentation: Impact on measuring COVID-19 vaccine effectiveness

BACKGROUND: During the COVID-19 pandemic, self-reported COVID-19 vaccination might facilitate rapid evaluations of vaccine effectiveness (VE) when source documentation (e.g., immunization information systems [IIS]) is not readily available. We evaluated the concordance of COVID-19 vaccination status ascertained by self-report versus source documentation and its impact on VE estimates. METHODS: Hospitalized adults (≥18 years) admitted to 18 U.S. medical centers March-June 2021 were enrolled, including COVID-19 cases and SARS-CoV-2 negative controls. Patients were interviewed about COVID-19 vaccination. Abstractors simultaneously searched IIS, medical records, and other sources for vaccination information. To compare vaccination status by self-report and documentation, we estimated percent agreement and unweighted kappa with 95% confidence intervals (CIs). We then calculated VE in preventing COVID-19 hospitalization of full vaccination (2 doses of mRNA product ≥14 days prior to illness onset) independently using data from self-report or source documentation. RESULTS: Of 2520 patients, 594 (24%) did not have self-reported vaccination information to assign vaccination group; these patients tended to be more severely ill. Among 1924 patients with both self-report and source documentation information, 95.0% (95% CI: 93.9-95.9%) agreement was observed, with a kappa of 0.9127 (95% CI: 0.9109-0.9145). VE was 86% (95% CI: 81-90%) by self-report data only and 85% (95% CI: 81-89%) by source documentation data only. CONCLUSIONS: Approximately one-quarter of hospitalized patients could not provide self-report COVID-19 vaccination status. Among patients with self-report information, there was high concordance with source documented status. Self-report may be a reasonable source of COVID-19 vaccination information for timely VE assessment for public health action