Objective
Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision‐making ...contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life‐sustaining treatments and care utilisation to inform their broader use in ACP studies.
Methods
Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity.
Results
Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's = .31–.37, p < .001), and ACP engagement (r's = −.41 to −.37, p < .001) indicated convergent validity.
Conclusion
A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement.
Patient or Public Contribution
The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life‐limiting conditions and five current or former care partners.
We investigated whether plasma high-sensitivity cardiac troponin T (hs-cTnT) and circulating heart-associated microRNA (miRs) are increased in children with leukaemias during anthracycline-based ...chemotherapeutic treatment.
In vitro human pluripotent stem cell (hPSC)-derived cardiomyocyte model showed that miR-1, miR-133a, miR-208a, miR-208b, and miR-499 are released from cells into culture medium in a time- and dose-dependent manner on doxorubicin exposure. Left ventricular (LV) myocardial deformation and circulating heart-associated miRs and plasma hs-cTnT during and after completion of chemotherapy were determined in 40 children with newly diagnosed acute leukaemia.
Significant reduction of LV global longitudinal strain and strain rates were found within 1 week after completion of anthracycline therapy in the induction phase of treatment (all p < 0.05). Hs-cTnT level peaked and miR-1 increased significantly at this time point. Log-transformed hs-cTnT correlated negatively with LV global systolic longitudinal strain (r = -0.38, p < 0.001). Receiver operating characteristic analysis revealed that area under the curve for changes in plasma hs-cTnT from baseline and plasma miR-1 levels in detecting a reduction in ≥20% of global longitudinal strain were respectively 0.62 (95% CI 0.38-0.87) and 0.62 (95% CI 0.40-0.84).
Plasma hs-cTnT and circulating miR-1 may be useful markers of myocardial damage during chemotherapy in children with leukaemias.
Heart-associated miRNAs including miR-1, miR-133a, miR-208a, miR-208b,and miR-499 were increased in the culture medium upon exposure of hPSC-derived cardiomyocytes to doxorubicin. Only miR-1 increased significantly during anthracycline-based therapy in paediatric leukaemic patients. In paediatric leukaemic patients, plasma hs-cTnT and circulating level of miR-1 showed the most significant increase within 1 week after completion of anthracycline therapy in the induction treatment phase. The study provides the first evidence of progressive increase in circulating miR-1 and plasma hs-cTnT levels during the course of anthracycline-based therapy in children with leukaemias, with hs-cTnT level also associated with changes in LV myocardial deformation.
Inspired by the multifunctionality of biological surfaces necessary for the survival of an organism in its specific environment, we developed an artificial special wetting nanofur surface which can ...be adapted to perform different functionalities necessary to efficiently separate oil and water for cleaning accidental oil spills or separating industrial oily wastewater. Initial superhydrophobic nanofur surface is fabricated using a hot pulling method, in which nano- and microhairs are drawn out of the polymer surface during separation from a heated sandblasted steel plate. By using a set of simple modification techniques, which include microperforation, plasma treatment and subsequent control of storage environment, we achieved selective separation of either water or oil, variable oil absorption and continuous gravity driven separation of oil/water mixtures by filtration. Furthermore, these functions can be performed using special wetting nanofur made from various thermoplastics, including biodegradable and recyclable polymers. Additionally, nanofur can be reused after washing it with organic solvents, thus, further helping to reduce the environmental impacts of oil/water separation processes.
Abstract In order to slow the spread of COVID-19, on March 23, 2020, a strict lockdown was implemented in the UK. This was followed by alternating periods of less restrictive lockdowns until most ...public health restrictions were lifted in the summer of 2021. While these measures were necessary, they significantly affected people’s daily activities, lifestyles, and mental well-being. This paper presents a longitudinal research study that focused on females aged 55 + in the UK, aiming to understand how COVID-19 and the subsequent 15-month period of lockdowns affected their lifestyles and emotions. The study collected data through online surveys, where respondents reported the frequency and mode of access to activities, and their positive and negative emotional experiences during distinct study phases that encompassed both lockdown and less strict periods. In contrast to previous studies highlighting vulnerabilities for females and the elderly during lockdowns, this research found that the studied group maintained an overall positive outlook throughout the study period and successfully adapted to the lockdowns by increasing their engagement in certain activities, in particular, activities like ‘getting active’. In addition, our findings indicate rapid adaptive behaviour change towards many online activities, such as cultural activities. However, the study also revealed negative emotions and a decrease in some activities during the second lockdown in 2020 and the subsequent lockdowns in 2021, underscoring the challenges inherent in prolonged periods of confinement. In addition, the study found negative affect associated with some activities, including working and studying from home. The findings provide valuable insights into how females aged over 55 coped with stressful circumstances, which can inform the development of resilient and mental health-conscious public health policies and responses in preparation for future pandemics or other hazards.
A small randomized controlled trial suggested that dabigatran may be as effective as warfarin in the treatment of cerebral venous thrombosis (CVT). We aimed to compare direct oral anticoagulants ...(DOACs) to warfarin in a real-world CVT cohort.
This multicenter international retrospective study (United States, Europe, New Zealand) included consecutive patients with CVT treated with oral anticoagulation from January 2015 to December 2020. We abstracted demographics and CVT risk factors, hypercoagulable labs, baseline imaging data, and clinical and radiological outcomes from medical records. We used adjusted inverse probability of treatment weighted Cox-regression models to compare recurrent cerebral or systemic venous thrombosis, death, and major hemorrhage in patients treated with warfarin versus DOACs. We performed adjusted inverse probability of treatment weighted logistic regression to compare recanalization rates on follow-up imaging across the 2 treatments groups.
Among 1025 CVT patients across 27 centers, 845 patients met our inclusion criteria. Mean age was 44.8 years, 64.7% were women; 33.0% received DOAC only, 51.8% received warfarin only, and 15.1% received both treatments at different times. During a median follow-up of 345 (interquartile range, 140-720) days, there were 5.68 recurrent venous thrombosis, 3.77 major hemorrhages, and 1.84 deaths per 100 patient-years. Among 525 patients who met recanalization analysis inclusion criteria, 36.6% had complete, 48.2% had partial, and 15.2% had no recanalization. When compared with warfarin, DOAC treatment was associated with similar risk of recurrent venous thrombosis (aHR, 0.94 95% CI, 0.51-1.73;
=0.84), death (aHR, 0.78 95% CI, 0.22-2.76;
=0.70), and rate of partial/complete recanalization (aOR, 0.92 95% CI, 0.48-1.73;
=0.79), but a lower risk of major hemorrhage (aHR, 0.35 95% CI, 0.15-0.82;
=0.02).
In patients with CVT, treatment with DOACs was associated with similar clinical and radiographic outcomes and favorable safety profile when compared with warfarin treatment. Our findings need confirmation by large prospective or randomized studies.
A high-performance liquid chromatography coupled with diode array detector and mass spectrometry (HPLC–DAD-MS) method was developed to evaluate the quality of Rhizoma Belamcandae (
Belamcanda ...chinensis (L.) DC.) through establishing chromatographic fingerprint and simultaneous determination of seven phenolic compounds. The analysis was achieved on an Alltima C
18 analytical column (250
mm
×
4.6
mm i.d. 5
μm) using linear gradient elution of acetonitrile–0.1% trifluoroacetic acid. The correlation coefficients of similarity were determined from the HPLC fingerprints, and they shared a close similarity. By using an online APCI–MS/MS, twenty phenols were identified. In addition, seven of these phenols including mangiferin, 7-
O-methylmangiferin, tectoridin, resveratrol, tectorigenin, irigenin and irisflorentin were quantified by the validated HPLC–DAD method. These phenols are considered to be major constituents in Rhizoma Belamcandae, and are generally regarded as the index for quality assessment of this herb. This developed method by having a combination of chromatographic fingerprint and quantification analysis could be applied to the quality control of Rhizoma Belamcandae.
This longitudinal study determines the frequency and way of people doing activities from Spring 2020 to Summer 2021 during different phases of the COVID-19 pandemic in the UK. Six online surveys were ...carried out between April 2020 and July 2021. 4,992 participants were engaged in the cross-sectional study and 203 participants who provided repeat responses were included in the subset sample of prospective cohort analysis. Primary outcomes measured were the frequency and the mode of doing the activities (online or in-person) across sixteen selected activity groups, as defined by the UK National Time Use Survey. The results show that cultural activities, spending time with others, and travelling, were the activities with the largest proportions of frequency and mode changes. The most significant changes occurred from March to June 2020, a period that included the first lockdown. Survey results from this period show a significant decrease among most of the sixteen measured activities. From March to October 2020, a period which spans the first lockdown and its subsequent ease of restrictions, showed the most significant shift from accessing activities in-person to online. Despite 'Freedom Day', the July 19.sup.th 2021 date in which all restrictions were abolished, it was found that people do cultural activities and group activities at a significantly lower frequency than before the pandemic. In addition, despite a lack of restrictions after this date, more than half of participants access many activities, such as spending time with others, shopping, work and studying, online or hybrid. This study provides an invaluable insight into understanding how people in the UK changed their lifestyle, including what activities they do, and how they accessed those activities in light of the COVID-19 pandemic and related public health policy implemented to address the pandemic. These results may serve as unique evidence for policymakers.
Measurements on ultrathin body negative-capacitance (NC) field-effect transistors are shown to display subthreshold behaviors that cannot be explained as a classical MOSFET. Subthreshold swing (SS) ...at low drain bias decreases with increased gate bias for devices measured over multiple gate lengths down to 30 nm. In addition, improvement in the SS relative to control devices shows a nonmonotonic dependence on the gate length. Using a Landau-Khalatnikov ferroelectric (FE) model calibrated with measured Capacitance-Voltage and combining it with TCAD simulations, we show that these anomalous behaviors can be quantitatively explained and interpreted as field-induced permittivity enhancement. The model predicts substantial scaling improvement at the end of the roadmap.
The
lncRNA mediates X chromosome inactivation (XCI). Here we show that Spen, an
-binding repressor protein essential for XCI , binds to ancient retroviral RNA, performing a surveillance role to ...recruit chromatin silencing machinery to these parasitic loci. Spen loss activates a subset of endogenous retroviral (ERV) elements in mouse embryonic stem cells, with gain of chromatin accessibility, active histone modifications, and
RNA transcription. Spen binds directly to
RNAs that show structural similarity to the A-repeat of
, a region critical for
-mediated gene silencing.
RNA and
A-repeat bind the RRM domains of Spen in a competitive manner. Insertion of an ERV into an A-repeat deficient Xist rescues binding of
RNA to Spen and results in strictly local gene silencing in
. These results suggest that
may coopt transposable element RNA-protein interactions to repurpose powerful antiviral chromatin silencing machinery for sex chromosome dosage compensation.
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