Search

Introduction Health research bodies recommend patient involvement and engagement in research and healthcare planning, although their implementation is not yet widespread. This deficiency extends to progressive pulmonary fibrosis (PPF), where crucial aspects remain unknown, including causal mechanisms, curative treatments and optimal symptom management. This study addresses these gaps by seeking stakeholders’ perspectives to guide research and treatment directions.Method A priority-setting partnership was established to explore stakeholders’ priorities in the diagnosis, treatment, management and care of PPF, including idiopathic pulmonary fibrosis which is the archetypal PPF. Stakeholders included people living with PPF, their carers, relatives and healthcare professionals involved in their management.Results Through an online open-ended survey, 2542 responses were collected from 638 stakeholders. Thematic analysis identified 48 specific research questions, which were then cross-referenced with academic literature to pinpoint research gaps. Following the evidence check, 44 unanswered questions were shortlisted by 834 stakeholders in a second online survey. Ultimately, a top 10 priority list was established through consensus.The prioritised research questions include (1) improved diagnosis accuracy and timing, (2) development of new treatments, (3) enhanced accuracy in primary care, (4) optimal timing for drug and non-drug interventions, (5) effective cough treatment, (6) early intervention for PPF, (7) improved survival rates, (8) symptom reduction, (9) impact of interventions on life expectancy and (10) new treatments with reduced side effects.Conclusion Stakeholders’ priorities can be summarised into five areas: early diagnosis, drug and non-drug treatments, survival and symptom management. Ideally, these topics should guide funding bodies and health policies.

Objectives Mycophenolate mofetil (MMF) and azathioprine (AZA) are immunomodulatory treatments in interstitial lung disease (ILD). This systematic review aimed to evaluate the efficacy of MMF or AZA on pulmonary function in ILD.Design Population included any ILD diagnosis, intervention included MMF or AZA treatment, outcome was delta change from baseline in per cent predicted forced vital capacity (%FVC) and gas transfer (diffusion lung capacity of carbon monoxide, %DLco). The primary endpoint compared outcomes relative to placebo comparator, the secondary endpoint assessed outcomes in treated groups only.Eligibility criteria Randomised controlled trials (RCTs) and prospective observational studies were included. No language restrictions were applied. Retrospective studies and studies with high-dose concomitant steroids were excluded.Data synthesis The systematic search was performed on 9 May. Meta-analyses according to drug and outcome were specified with random effects, I2 evaluated heterogeneity and Grading of Recommendations, Assessment, Development and Evaluation evaluated certainty of evidence. Primary endpoint analysis was restricted to RCT design, secondary endpoint included subgroup analysis according to prospective observational or RCT design.Results A total of 2831 publications were screened, 12 were suitable for quantitative synthesis. Three MMF RCTs were included with no significant effect on the primary endpoints (%FVC 2.94, 95% CI −4.00 to 9.88, I2=79.3%; %DLco −2.03, 95% CI −4.38 to 0.32, I2=0.0%). An overall 2.03% change from baseline in %FVC (95% CI 0.65 to 3.42, I2=0.0%) was observed in MMF, and RCT subgroup summary estimated a 4.42% change from baseline in %DLCO (95% CI 2.05 to 6.79, I2=0.0%). AZA studies were limited. All estimates were considered very low certainty evidence.Conclusions There were limited RCTs of MMF or AZA and their benefit in ILD was of very low certainty. MMF may support preservation of pulmonary function, yet confidence in the effect was weak. To support high certainty evidence, RCTs should be designed to directly assess MMF efficacy in ILD.PROSPERO registration number CRD42023423223.

Abstract Pulmonary hypertension (PH) adds a substantial disease burden, including higher mortality, when associated with interstitial lung disease (ILD), a severe, chronic, progressive condition. Yet little is known of the lived experiences, perspectives, priorities, and viewpoints of patients and carers living with PH‐ILD. The Voice of the Patient meeting at the center of this qualitative research study aims to provide these difficult‐to‐obtain insights from a European perspective for the first time. The multistakeholder approach brought together four PH‐ILD patients, three primary caregivers, two patient associations, clinical experts, sponsor representatives, and a facilitator. Of the six major themes identified in the thematic analysis, symptoms, and physical limitations were the most impactful. Shortness of breath was the most bothersome symptom affecting patients daily. Further symptoms included fatigue, cough, dizziness, syncope, edema, and palpitations. Physical limitations focused on reduced mobility, impacting patients’ ability to perform daily tasks, hobbies, sports, and to enjoy travel. Existing antifibrotic and pulmonary arterial hypertension‐targeted treatments were perceived as beneficial. However, despite advances in treatment, severe disease burdens and high unmet medical needs persist from the perspectives of patients. Most meaningful to patients’ daily wellbeing was supplemental oxygen, enabling greater mobility. Patients and carers reported difficulties and barriers in navigating the healthcare system and obtaining adequate information to reduce their considerable uncertainties, documenting the substantial challenges that rare and complex conditions such as PH‐ILD pose for routine clinical practice beyond PH expert centers and indicating an urgent need for high‐quality patient‐ and clinician‐directed information to support patient‐centered care.

BackgroundDespite the high prevalence of mental health difficulties in children and young people with long-term health conditions (LTCs), these difficulties and experiences are often overlooked and untreated. Previous research demonstrated the effectiveness of psychological support provided via a drop-in mental health centre located in a paediatric hospital. The aim of this prospective non-randomised single-arm multi-centre interventional study is to determine the clinical effectiveness of drop-in mental health services when implemented at paediatric hospitals in England.MethodsIt is hypothesised that families who receive psychological interventions through the drop-in services will show improved emotional and behavioural symptoms. Outcomes will be measured at baseline and at 6-month follow-up. The primary outcome is the difference in the total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) reported by parent or child at 6 months. Secondary outcomes include self and parent reported Paediatric Quality of Life Inventory (PedsQL), self-reported depression (PHQ-9) and anxiety measures (GAD-7) and family satisfaction (CSQ-8).DiscussionThis trial aims to determine the clinical effectiveness of providing psychological support in the context of LTCs through drop-in mental health services at paediatric hospitals in England. These findings will contribute to policies and practice addressing mental health needs in children and young people with other long-term health conditions.Trial registrationISRCTN15063954, Registered on 9 December 2022.

Progressive pulmonary fibrosis (PF) is a complex interstitial lung disease that impacts substantially on patients' daily lives, requiring personalised and integrated care. We summarise the main needs of patients with PF and their caregivers, and suggest a supportive care approach. Individualised care, education, emotional and psychological support, specialised treatments, and better access to information and resources are necessary. Management should start at diagnosis, be tailored to the patient's needs, and consider end-of-life care. Pharmacological and non-pharmacological interventions should be individualised, including oxygen therapy and pulmonary rehabilitation, with digital healthcare utilised as appropriate. Further research is needed to address technical issues related to oxygen delivery and digital healthcare. Educational aims To identify the main needs of patients with PF and their caregivers. To describe the components of a comprehensive approach to a supportive care programme for patients with PF. To identify further areas of research to address technical issues related to the management of patients with PF.

Background Patient recruitment and retention are a challenge when conducting clinical trials in patients with pulmonary fibrosis, including idiopathic pulmonary fibrosis and other interstitial lung diseases. This study aimed to understand and address the barriers associated with trial participation for these populations. Methods Nine patients, nine caregivers and three healthcare professionals participated in virtual simulations of planned phase III trials. During the simulations, participants received information about the trials and either tested a home spirometry device or watched a home spirometry demonstration, before providing their insights in debriefs. The findings were interpreted in advisory boards with representatives from patient organisations and expert investigators. Results Regarding barriers to participation, patient fatigue and breathlessness were emphasised as posing challenges for travel, visit length and completion of onsite assessments. Lack of information, support and appreciation were also identified as factors that may exacerbate anxiety and negatively affect participant retention rates. Feedback on the home spirometry was mixed, with participants appreciating being able to complete the test at home but worrying about device handling. Based on the insights gained, patient-friendly adaptations were made to the trial protocol and conduct, including remote assessment of patient-reported outcomes, increased visit flexibility, travel support services, patient and caregiver information campaigns, and training of investigators on patients’ needs. Conclusions Participants identified important barriers to participation, which led to patient-friendly changes being made to the planned trials. As a result, participation in the planned trials should be less burdensome, with improved recruitment and retention rates, and ultimately, improved data quality.

Note: Download statistics restarted from zero effective January 1, 2024. Please follow this link to see cumulative download statistics from our previous publishing platform: CPO Download Statistics 2012 - 2023

Materials needed to achieve designed performance will require formulations and processing methods capable of delivering a compendium of metallic, ceramic and cermet chemistries, which must be finely tuned at source, and tolerant to down-stream thermomechanical adjustment. Structural steels and cermets are continuously being developed by researchers using computational thermodynamics modelling and modified thermomechanical treatments, with oxide dispersion strengthened steel (ODS)-reduced activated ferritic-martensitic steel (RAFM) steels based on 8%–16% wt.% Cr now being assessed. The combination of SiC _f and CuCrZr as a metal matrix composite containing an active coolant would be seen as a major opportunity, furthermore, composite ceramic materials consisting of SiC fibres reinforcing a SiC matrix capable of being joined to metallic structures offer great potential in the development of advanced heat exchangers. Continuing the theme of advanced manufacturing, the use of solid-state processing technologies involving powder metallurgy–hot isostatic pressing and spark plasma sintering to produce near-net shaped products in metallics, ceramics and cermets are critical manufacturing research themes. Additive manufacturing (AM) to produce metallic and ceramic components is now becoming a feasible manufacturing route, and through the combination of AM and subtractive machining, capability exists to produce efficient fluid carrying structures that could not be manufactured by any other process. Extending this to using electron beam welding and advanced heat treatments to improve homogeneity and provide modularity, a two-pronged solution is now available to improve capability and integrity, whilst concurrently offering increased degrees of freedom for designers.

Self-management, as a strategy to support those living with chronic respiratory conditions such as asthma and COPD, has been widely advocated in guidelines and adopted in practice. However, there can be a disconnect between the goals of patients and healthcare professionals. Goals and barriers to self-management are often compounded by the complex social, emotional and medical needs of patients. People living with chronic respiratory conditions also often have symptoms of anxiety and depression, which can impact on self-management. Self-management therefore requires patients and healthcare professionals to work together and it is essential to involve patients when designing, implementing and evaluating self-management interventions. Patient preferences are clearly important and goal setting needs an individual, flexible and responsive approach from healthcare professionals, which aligns to a more personalised approach to management of treatable traits and the burden of disease. To achieve these goals, healthcare professionals need education to support patients in self-management and behaviour change. This approach should lead to shared decision-making and partnership working that puts the patient right at the centre of their care.

Abstract Voice-based personal assistants using artificial intelligence (AI) have been widely adopted and used in home-based settings. Their success has created considerable interest for its use in healthcare applications; one area of prolific growth in AI is that of voice-based virtual counselors for mental health and well-being. However, in spite of its promise, building realistic virtual counselors to achieve higher-order maturity levels beyond task-based interactions presents considerable conceptual and pragmatic challenges. We describe one such conceptual challenge—cognitive plausibility, defined as the ability of virtual counselors to emulate the human cognitive system by simulating how a skill or function is accomplished. An important cognitive plausibility consideration for voice-based agents is its ability to engage in meaningful and seamless interactive communication. Drawing on a broad interdisciplinary research literature and based on our experiences with developing two voice-based (voice-only) prototypes that are in the early phases of testing, we articulate two conceptual considerations for their design and use—conceptualizing voice-based virtual counselors as communicative agents and establishing virtual co-presence. We discuss why these conceptual considerations are important and how it can lead to the development of voice-based counselors for real-world use.

Introduction: Pulmonary fibrosis includes a spectrum of diseases and is incurable. There is a variation in disease course, but it is often progressive leading to increased breathlessness, impaired quality of life, and decreased life expectancy. Detection of pulmonary fibrosis is challenging, which contributes to considerable delays in diagnosis and treatment. More knowledge about the diagnostic journey from patients' perspective is needed to improve the diagnostic pathway. The aims of this study were to evaluate the time to diagnosis of pulmonary fibrosis, identify potential reasons for delays, and document patients emotions.Methods: Members of European patient organisations, with a self-reported diagnosis of pulmonary fibrosis, were invited to participate in an online survey. The survey assessed the diagnostic pathway retrospectively, focusing on four stages: (1) time from initial symptoms to first appointment in primary care; (2) time to hospital referral; (3) time to first hospital appointment; (4) time to final diagnosis. It comprised open-ended and closed questions focusing on time to diagnosis, factors contributing to delays, diagnostic tests, patient emotions, and information provision.Results: Two hundred and seventy three participants (214 idiopathic pulmonary fibrosis, 28 sarcoidosis, 31 other) from 13 countries responded. Forty percent of individuals took ≥1 year to receive a final diagnosis. Greatest delays were reported in stage 1, with only 50.2% making an appointment within 3 months. For stage 2, 73.3% reported a hospital referral within three primary care visits. However, 9.9% reported six or more visits. After referral, 76.9% of patients were assessed by a specialist within 3 months (stage 3) and 62.6% received a final diagnosis within 3 months of their first hospital visit (stage 4). Emotions during the journey were overall negative. A major need for more information and support during and after the diagnostic process was identified.Conclusion: The time to diagnose pulmonary fibrosis varies widely across Europe. Delays occur at each stage of the diagnostic pathway. Raising awareness about pulmonary fibrosis amongst the general population and healthcare workers is essential to shorten the time to diagnosis. Furthermore, there remains a need to provide patients with sufficient information and support at all stages of their diagnostic journey.

Children with respiratory diseases take treatments for the self-management of symptoms and to maintain disease control. Often, these treatments need to be taken in social environments like school. Respiratory treatments can foster a feeling of difference and stigmatisation, which negatively impact on the quality of life and adherence to treatment. Such perceptions can lead to a less than optimal disease control, a vicious cycle leading to further social exclusion and stigma. This aspect of “burden of treatment” is poorly recognised by clinicians. Recognition of how treatments and clinical practice can contribute to stigma, can help address this burden of care. Educational aims To understand the meaning of the term “stigma” within the context of respiratory health conditions and how medication or treatments can contribute to stigma in children and young people. To understand the potential impact of stigma on adherence, disease control and quality of life. To consider strategies to manage the stigma associated with health treatments across spheres of influence.

The management of respiratory diseases requires various levels of care: multidisciplinary teams, educational and behavioural interventions, self-management and home-based technical support are vital to ensure adequate care management. However, it is often difficult to access these networks due to fragmentation of patient care and treatment burden. Care coordination aims to ensure patients have a central role and that there is continuity of care among various levels and professionals involved. Moreover, the coronavirus disease pandemic has caused strain on the global healthcare system, with care coordination becoming increasingly important in increasing the resilience of health systems, supporting healthcare professionals and ensuring the right treatment and adequate level of care for these patients.

PurposeTo investigate the stress-strain behaviour of 9 soft contact lens materials, that are commonly used in the market, under uniaxial compression loading.MethodsSeven types of hydrogel and two types of silicone-hydrogel soft contact lens materials were hydrated in phosphate-buffered saline (PBS) solution then subjected to uniaxial compression loads. The load rate was set to 16.0 N/min starting with two consecutive initial 5.0 N loading cycles followed by three relaxation periods of 4.0 min within which there were two more 5.0 N loading cycles and eventually, a full loading cycle that stopped at a load of 49.0 N. The load and contraction data obtained experimentally were analysed to derive the stress-strain behaviour. Finite Element (FE) analysis was then utilised to evaluate the performance of soft contact lenses on the human eye and handling lenses off the eye.ResultsUnlike tensile tests, all tested materials showed nonlinear behaviour when tested under compression. When fitted to first-order Ogden hyperelastic model, parameter μ was found to be varying in the range 0.12 to 0.74 MPa and material parameter α was found to be varying in the range 8.2 to 20.326 among the nine tested materials. Compression modulus of elasticity was 2.2 times higher than the tensile modulus of elasticity on average. FE simulation with nonlinear Ogden constitutive model showed a limited change (8%~12%) in the optical performance when compared to other material models, however, it predicted higher stress when the lens was simulated under bending during off-eye handling.ConclusionsCompression tests revealed slightly nonlinear behaviour when materials were strained under compression stress down to 15% ~ 30% of their nominal heights. Considering the physiological compression loading range of 8 mmHg, secant moduli of elasticity were 1.5% to 6.9% higher than the tension moduli of elasticity depending on the material. Tensile-based moduli of elasticity could be used in FE analysis as a step towards simulating the optical performance of soft contact lenses on-eye. However, nonlinear compression-based material models are recommended for FE analysis of soft contact lenses when lens-handling is investigated off-eye.

Introduction Sex hormone binding globulin (SHBG) levels are reported to be inversely associated with diabetes risk. It is unknown whether diabetes prevention interventions increase SHBG and whether resultant changes in SHBG affect diabetes risk. The purpose of this analysis was to determine whether intensive lifestyle intervention (ILS) or metformin changed circulating SHBG and if resultant changes influenced diabetes risk in the Diabetes Prevention Program (DPP).Research design and methods This is a secondary analysis from the DPP (1996–2001), a randomized trial of ILS or metformin versus placebo on diabetes risk over a mean follow-up of 3.2 years. The DPP was conducted across 27 academic study centers in the USA. Men, premenopausal and postmenopausal women without hormone use in the DPP were evaluated. The DPP included overweight/obese persons with elevated fasting glucose and impaired glucose tolerance. Main outcomes measures were changes in SHBG levels at 1 year and risk of diabetes over 3 years.Results ILS resulted in significantly higher increases (postmenopausal women: p

PurposeThis study investigates how both the peripheral zone design and corneal shape affect the behaviour of soft contact lenses on-eye.MethodsIn this study, soft contact lenses of varying nominal cylindrical powers and peripheral zone designs-a single-prism gravity-based stabilised lens (G1P), two-prism blink-based stabilised lens (B2P) and four-prism blink-based stabilised lens (B4P)-were generated as finite element models. The on-eye simulation results were analysed to identify the impact of each peripheral zone design (Each with different volume ratios) on the effective power change (EPC) when worn by a subject. Topographies of three eyes of varying average simulated anterior corneal curvature (flat, average & steep) were used in this study.ResultsThe volume of the lens's peripheral zone as a ratio of the total lens volume (Vp) recorded very weak correlations with the effective power change (EPC) among the three investigated designs when they were fitted to the flat eye (R = -0.19, -0.15 & -0.22 respectively), moderate correlations with the average eye (R = 0.42, 0.43 & 0.43 respectively) and strong correlations with the steep eye (R = 0.91, 0.9 & 0.9 respectively). No significant differences were noticed among the three investigated designs and none of the cylindrical lenses designed with axis 90° recorded EPC values outside the acceptance criteria range (ACR) of ±0.25 D. No significant differences in EPC were recorded among the three designs G1P, B2P and B4P (p>0.6) when they were designed with three axes at 90°, 45° and 0°. Moving the toric lens axis away from 90° dragged the EPC to the negative side and most of the investigated lenses with axes at 45° and 0° recorded EPCs outside the ±0.25D range.ConclusionsIn all cases, the shape of the cornea had a more dominant effect on EPC when compared to the peripheral zone design. Corneal shape influences the soft toric contact lens's on-eye power change more than the lens design.

O objetivo do estudo foi identificar o comportamento responsável de empresas de turismo no Brasil e seus motivos para implementar tais ações. A pesquisa obteve 1.350 respostas de empresas de turismo pertencentes a diversos segmentos, tais como alojamento, viagens, alimentação e transporte turístico. A metodologia foi composta por coleta de dados quantitativa via internet, seguida de interpretação baseada em estatística descritiva e análise de clusters. Os resultados indicaram que, entre as empresas de turismo do Brasil, as medidas ambientais são as mais frequentemente implementadas, com destaque para aquelas voltadas para a economia de energia ou água. A análise evidenciou dois grupos distintos, respaldados pelo referencial teórico, quando se trata das razões para implementar as práticas responsáveis: um com foco nos negócios e outro com foco nos indivíduos. Enquanto o primeiro apresenta razões inerentes ao negócio, tais como redução de custos e ampliação da competitividade; o outro grupo tem motivos ligados ao modo de vida e aos valores do indivíduo. O grupo, que tem motivações centradas no indivíduo, revelou-se maior e com mais implementações das medidas investigadas nos três pilares da sustentabilidade. Por fim, não houve constatação de diferenças no desempenho financeiro entre empresas dos dois grupos.

Introduction Pulmonary fibrosis (PF) and its most common form, idiopathic pulmonary fibrosis (IPF), are chronic, progressive diseases resulting in increasing loss of lung function and impaired quality of life and survival. The aim of this joint expert and patient statement was to highlight the most pressing common unmet needs of patients with PF/IPF, putting forward recommendations to improve the quality of life and health outcomes throughout the patient journey. Methods Two online surveys for patients and healthcare professionals (HCPs) were conducted by the European Idiopathic Pulmonary Fibrosis and Related Disorders Federation (EU-IPFF) in 14 European countries. Results The surveys were answered by 286 patients and 69 HCPs, including physicians and nurses. Delays in diagnosis and timely access to interstitial lung disease specialists and pharmacological treatment have been identified as important gaps in care. Additionally, patients and HCPs reported that a greater focus on symptom-centred management, adequate information, trial information and increasing awareness of PF/IPF is required. Conclusions The surveys offer important insights into the current unmet needs of PF/IPF patients. Interventions at different points of the care pathway are needed to improve patient experience.

Tungsten inert gas (TIG) welding of austenitic stainless steels is a critical process used in industries. Several properties of the welds must be controlled depending on the application. These properties, which include the geometrical, mechanical and microstructural features, can be modified through an appropriate composition of shielding gas. Researchers have studied the effects of the addition of nitrogen through the shielding gas; however, due to limited amount of experimental data, many of the interaction effects are not yet reported. In this study, welds were made homogeneously as well as heterogeneously with various concentrations of nitrogen added through the shielding gas. The gas compositions used were 99.99%Ar (pure), 2.5% N2 + Ar, 5% N2 + Ar and 10% N2 + Ar. Additionally, the welding process parameters were varied to understand different interaction effects between the shielding gas chemistry and the process variables such as filler wire feed rate, welding current, etc. Strong interactions were observed in the case of heterogeneous welds between the gas composition and the filler wire feed rate, with the penetration depth increasing by nearly 30% with the addition of 10% nitrogen in the shielding gas. The interactions were found to influence the bead geometry, which, in turn, had an effect on the mechanical properties as well as the fatigue life of the welds. A nearly 15% increase in the tensile strength of the samples was observed when using 10% nitrogen in the shielding gas, which also translated to a similar increase in the fatigue life.

Using baffles in exhaust mufflers is known to improve their transmission loss. The baffle cut ratio should affect the muffler performance analogous to a shell-and-tube heat exchanger. To the authors’ knowledge, there is no previous assessment reported in literature of the effects that the baffle cut ratio configuration has on acoustic response and back pressure. This investigation presents a parametric study on the effect of baffle configuration on transmission loss and pressure drop predicted. The effect of (i) the baffle cut ratio and baffle spacing, (ii) the number of baffle holes, and (iii) the hole distribution for their effect on transmission loss was investigated. Results show that decreasing the baffle cut ratio tends to increase the transmission loss at intermediate frequencies by up to 45%. Decreasing the spacing between muffler plates was shown to enhance the muffler transmission loss by 40%. To assess the baffle effect on flow, the OpenFoam CFD libraries were utilized using the thermal baffle approach model. Baffles were found to cause sudden drop in fluid temperature in axial flow direction. The outlet exhaust gases temperature was found to decrease by 15% as the baffle cut ratio changed from 75% to 25%.

Over the last century within the philosophy of mind, the intersubjective model of self has gained traction as a viable alternative to the oft-criticised Cartesian solipsistic paradigm. These two models are presented as incompatible inasmuch as Cartesians perceive other minds as “a problem” for the self, while intersubjectivists insist that sociality is foundational to selfhood. This essay uses the Paranormal Activity series (2007–2015) to explore this philosophical debate. It is argued that these films simultaneously evoke Cartesian premises (via found-footage camerawork), and intersubjectivity (via an ongoing narrative structure that emphasises connections between the characters, and between each film). The philosophical debates illuminate premises on which the series’ story and horror depends. Moreover, Paranormal Activity also sheds light on the theoretical debate: the series brings those two paradigms together into a coherent whole, thereby suggesting that the two models are potentially compatible. By developing a combined model, scholars working in the philosophy of mind might better account for the different aspects of self-experience these paradigms focus on.

The European Research Infrastructure Consortium “Integrated Carbon Observation System” (ICOS) aims at delivering high quality greenhouse gas (GHG) observations and derived data products (e.g., regional GHG-flux maps) for constraining the GHG balance on a European level, on a sustained long-term basis. The marine domain (ICOS-Oceans) currently consists of 11 Ship of Opportunity lines (SOOP – Ship of Opportunity Program) and 10 Fixed Ocean Stations (FOSs) spread across European waters, including the North Atlantic and Arctic Oceans and the Barents, North, Baltic, and Mediterranean Seas. The stations operate in a harmonized and standardized way based on community-proven protocols and methods for ocean GHG observations, improving operational conformity as well as quality control and assurance of the data. This enables the network to focus on long term research into the marine carbon cycle and the anthropogenic carbon sink, while preparing the network to include other GHG fluxes. ICOS data are processed on a near real-time basis and will be published on the ICOS Carbon Portal (CP), allowing monthly estimates of CO2 air-sea exchange to be quantified for European waters. ICOS establishes transparent operational data management routines following the FAIR (Findable, Accessible, Interoperable, and Reusable) guiding principles allowing amongst others reproducibility, interoperability, and traceability. The ICOS-Oceans network is actively integrating with the atmospheric (e.g., improved atmospheric measurements onboard SOOP lines) and ecosystem (e.g., oceanic direct gas flux measurements) domains of ICOS, and utilizes techniques developed by the ICOS Central Facilities and the CP. There is a strong interaction with the international ocean carbon cycle community to enhance interoperability and harmonize data flow. The future vision of ICOS-Oceans includes ship-based ocean survey sections to obtain a three-dimensional understanding of marine carbon cycle processes and optimize the existing network design.

PurposeTo present a three-dimensional non-parametric method for detecting scleral asymmetry using corneoscleral topography data that are free of edge-effect artefacts.MethodsThe study included 88 participants aged 23 to 65 years (37.7±9.7), 47 women and 41 men. The eye topography data were exported from the Eye Surface Profiler software in MATLAB binary data container format then processed by custom built MATLAB codes entirely independent from the profiler software. Scleral asymmetry was determined initially from the unprocessed topography before being determined again after removing the edge-effect noise. Topography data were levelled around the limbus, then edge-effect was eliminated using a robust statistical moving median technique. In addition to comparing raw elevation data, scleral elevation was also compared through fitting a sphere to every single scleral surface and determining the relative elevation from the best-fit sphere reference surface.ResultsWhen considering the averaged raw topography elevation data in the scleral section of the eye at radius 8 mm, the average raw elevations of the right eyes' sclera were -1.5±1.77, -1.87±2.12, -1.36±1.82 and -1.57±1.87 mm. In the left eyes at the same radius the average raw elevations were -1.62±1.78, -1.82±2.07, -1.28±1.76 and -1.68±1.93 mm. While, when considering the average raw elevation of the sclera after removing the edge effect, the average raw elevations of the right eyes were -3.71±0.25, -4.06±0.23, -3.95±0.19 and -3.95±0.23 mm. In the left eyes at the same radius the average raw elevations were -3.71±0.19, -3.97±0.22, -3.96±0.19 and -3.96±0.18 mm in the nasal, temporal, superior and inferior sides respectively. Maximum raw elevation asymmetry in the averaged scleral raw elevation was 1.6647±0.9015 mm in right eyes and 1.0358±0.6842 mm in left eyes, both detected at -38° to the nasal side. Best-fit sphere-based relative elevation showed that sclera is more elevated in three main meridians at angles -40°, 76°, and 170° in right eyes and -40°, 76°, and 170° in left eyes, all measured from the nasal meridian. Maximum recorded relative elevation asymmetries were 0.0844±0.0355 mm and 0.068±0.0607 mm at angular positions 76° and 63.5° for right and left eyes in turn.ConclusionsIt is not possible to use corneoscleral topography data to predict the scleral shape without considering a method of removing the edge-effect from the topography data. The nasal side of the sclera is higher than the temporal side, therefore, rotationally symmetric scleral contact lenses are more likely to be translated towards the temporal side. The scleral shape is best described by levelled raw elevation rather than relative elevation.

PurposeTo evaluate the impact of soft contact lens eye-fit on optical power by computational modelling and to produce correction maps for reversing this impact during the design process.MethodsFinite element models of spherical and toric hydrogel contact lenses at varying nominal powers of -20 D to +20 D, base curves radii (R1b) of 8.2, 8.5, 8.8 mm, and overall diameters (d3) of 14.5, 15.0, 15.5 mm were generated. Lenses were fitted to computational eye models generated with human eyes' topography data. Combined eye-lens simulations were run under the boundary conditions of the tears' surface tension between the contact lens and the eye in addition to the eyelid blink pressure. Lens optical zone power changes were calculated through computational light-ray tracing methods following each simulation.ResultsEffective power changes (EPC) were affected negatively for all toric simulated lenses with power varying from -20 D to +20 D. Spherical lenses demonstrated similar behaviour, however with some positive EPC over the power range from -20 D to -10 D for spherical power (SPH) lenses. EPC assessment was between +0.25 D and -0.5 D for most lenses, however, lenses with prescriptions from +10 D to +20 D incurred EPC outside this range. The spherical lenses showed a maximum effective power change of +1.046 ± 0.338 D (Average Eye), and a minimum of -3.278 ± 0.731 D (Steep Eye). Similarly, the toric lenses showed a maximum of +1.501 ± 0.338 D (Average Eye), and a minimum of -3.514 ± 0.731 D (Steep Eye). EPC trends, along with minimum and maximum power, generally increased negatively as nominal lens prescription increased positively. Contact lens base curve selection affected the assessed effective power change for both spherical and toric lenses. The effect from lens total diameter for spherical lenses was less substantial than that for toric lenses.ConclusionsThis study considered the impact of soft contact lens design parameters on effective optical power changes (EPC) after eye-fit. Spherical lenses experienced more EPC of clinical significance (>0.25 D) than toric lenses. Both types of lenses, spherical and toric (simple astigmatism), demonstrated similar trends in EPC on fitting from -20 D to +20 D, with lenses in the extremely positive and the extremely negative prescriptions demonstrating the highest EPCs. The lens base curve impacted the extent of EPC observed, with flatter base curves experiencing less power change. Diameter proved to impact toric lenses more than spherical ones, however generally the diameter has less effect on power change than base curve selection.

Ultra-high performance fibre reinforced concrete (UHPFRC) is an innovative cement-based engineering material. The mechanical properties of UHPFRC not only depend on the properties of the concrete matrix and fibres, but also depend on the interaction between these two components. The fibre distribution is affected by many factors and previous researchers had developed different approaches to test the fibre distribution. This research adopted the non-destructive C-shape ferromagnetic probe inductive test and investigated the straight steel fibre distribution of the UHPFRC plate. A simplified characterization equation is introduced with an attenuation factor to consider the different plate thicknesses. The effective testing depth of this probe was tested to be 24 mm. By applying this method, fibre volume content and the fibre orientation angle can be calibrated for the entire plate. The fibre volume content generally fulfilled the design requirement. The fibre orientation angle followed a normal distribution, with a mean value of 45.60°. By testing small flexural specimens cut from the plates, it was found out that the mechanical performance (peak flexural strength) correlates with the product of fibre volume content and cosine fibre orientation angle.

Background: There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm. Methods: A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773). Results: Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors. Conclusion: There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward.

A number of evolutionary algorithms such as genetic algorithms, simulated annealing, particle swarm optimization, etc., have been used by researchers in order to optimize different manufacturing processes. In many cases these algorithms are either incapable of reaching global minimum or the time and computational effort (function evaluations) required makes the application of these algorithms impractical. However, if the Nelder Mead optimization method is applied to approximate solutions cheaply obtained from these algorithms, the solution can be further refined to obtain near global minimum of a given error function within only a few additional function evaluations. The initial solutions (vertices) required for the application of Nelder-Mead optimization can be obtained through multiple evolutionary algorithms. The results obtained using this hybrid method are better than that obtained from individual algorithms and also show a significant reduction in the computation effort.

PurposeTo present a novel non-parametric algorithm for detecting the position of the human eye limbus in three dimensions and a new dynamic method for measuring the full 360° visible iris boundary known as white-to-white distance along the eye horizontal line.MethodsThe study included 88 participants aged 23 to 65 years (37.7±9.7), 47 females and 41 males. Clinical characteristics, height data and the apex coordinates and 1024×1280 pixel digital images of the eyes were taken by an Eye Surface Profiler and processed by custom-built MATLAB codes. A dynamic light intensity frequency based white-to-white detection process and a novel three-dimensional method for limbus detection is presented.ResultsEvidence of significant differences (pConclusionsThe white-to-white distance in the human eye is significantly larger in the nasal-temporal direction than in the superior-inferior direction. The human limbus diameter was found not to vary significantly in these directions. The 3D measures show that the limbus contour does not lay in one plane and tends to be higher on the nasal-inferior side of the eye.

This article reports the results of a content and textual analysis of popular music criticism from the 1960s to the 2000s to discern the extent to which criticism has shifted focus from matters of music to matters of business. In part, we believe such a shift to be due likely to increased awareness among journalists and fans of the industrial nature of popular music production, distribution and consumption, and to the disruption of the music industry that began in the late 1990s with the widespread use of the Internet for file sharing. Searching and sorting the Rock’s Backpages database of over 22,000 pieces of music journalism for keywords associated with the business, economics and commercial aspects of popular music, we found several periods during which popular music criticism’s focus on business-related concerns seemed to have increased. The article discusses possible reasons for the increases as well as methods for analyzing a large corpus of popular music criticism texts

Prediction of weld bead geometry is critical for any welding process, since several mechanical properties of the weldment depend on this. Researchers have used artificial neural networks (ANNs) to predict the bead geometry based on the input parameters for a welding process; however, the number of hidden layers used in these ANNs are limited to one due to the small amount of data usually available through experiments. This results in a reduction in the accuracy of prediction. Such ANNs are also incapable of capturing sudden changes in the input−output trends; for example, where a wide range of heat inputs results in flat crown (zero crown height), but any further reduction in the current sharply increases the crown height. In this study, it was found that above mentioned issues can be resolved on using a two-stage algorithm consisting of support vector machine (SVM) and an ANN. The two-stage SVM−ANN algorithm significantly improved the accuracy of prediction and could be used as a replacement for the multiple hidden layer ANN, without requiring additional data for training. The improvement in prediction was evident near regions of sudden changes in the input−output correlation and can lead to a better prediction of mechanical properties.

This article examines hostile noise on the UK Guardian’s Bike Blog. Like the Internet, the bicycle has been framed as a redemptive technology at the heart of new forms of urbanity and citizenship. The article examines these struggles, concentrating on how accusations of trolling police the boundaries between cycling as a sphere of autonomous play and a more ‘ethical’ disposition that links cycling to environmental and social responsibility. It argues that a sense of community is established through the embattled relationship with a ‘petrolhead’ mode of online writing which asserts the pleasures of unrestrained lifestyle-as-fun and contests the claims to good citizenship made by pro-cycle bloggers. The article asks whether cycle blogging is constituted by its games of taste and its defensive response to trolling, or if conjoined strategies of netiquette and on-road etiquette framed in terms of ‘responsibility’, offer a route to legitimacy.

The potential for nutrition labels to impact on population health is dependent on consumer ability to understand and use this information. Consumer understanding of this information varies across sociodemographic groups and with different label design formats. Labeling legislation requires consumer education on how to use nutrition labels, and recent mandatory changes to the Nutrition Facts Panel (NFP) are underway to improve comprehensibility. This review aimed to evaluate if educational programs can improve understanding and use of nutrition labels. Database searches were performed to identify interventions which delivered education on nutrition labels with outcomes measuring aspects of comprehension or use. A total of 17 studies were selected for review, including nine randomized and eight cohort studies. The majority of studies were conducted in the United States Study participants included school aged children, older adults, and those with diabetes within a range of intervention types involving taught sessions or web-based education. Whilst outcome measures were heterogenous, all studies reported a statistically significant improvement in one or more outcomes of participant understanding or use of nutrition labels. Aspects such as general nutrition knowledge, health literacy, and program delivery format warrant attention in future research. Education which optimizes comprehension and use of nutrition labels may have the potential to improve the impact of this information on dietary health.

A new generation is changing the face of Holocaust remembrance, a morally laden subject that continues to captivate public imagination, spark controversy and generate dialogue, now by using social media. In summer 2010, controversy erupted worldwide as “Dancing Auschwitz,” a YouTube video of a Jewish family dancing at various Holocaust remembrance sites, defied the existing cultural narrative through a novel expression of Holocaust remembrance. The artifact exemplifies the larger debate whether technology aids memory as successfully as we believe or whether by freeing us from the burden encourages us to forget. We argue that virtual memorials can fulfill roles left vacant by more traditional forms of remembrance and open new avenues of communication and expression that allow participants, especially Germans and Jews, to re-mediate their identities. Virtual memorials can enhance the remembrance experience by cultivating fluid, interactive and creative spaces that encourage high degrees of participation, collaboration and self-expression. In the case study, YouTube users implemented three forms of remediation: role switching, redefinition, and disassociation. Despite the obstacles (e.g., destructive identity forces, commercial culture, and temporalities of social media trends), technology ultimately act as an aid to humanity’s deep-seated desire to remember.

Friedreich ataxia (FRDA) is an inherited neurodegenerative disorder caused by GAA repeat expansion within the FXN gene, leading to epigenetic changes and heterochromatin-mediated gene silencing that result in a frataxin protein deficit. Histone deacetylase (HDAC) inhibitors, including pimelic o-aminobenzamide compounds 106, 109 and 136, have previously been shown to reverse FXN gene silencing in short-term studies of FRDA patient cells and a knock-in mouse model, but the functional consequences of such therapeutic intervention have thus far not been described. We have now investigated the long-term therapeutic effects of 106, 109 and 136 in our GAA repeat expansion mutation-containing YG8R FRDA mouse model. We show that there is no overt toxicity up to 5 months of treatment and there is amelioration of the FRDA-like disease phenotype. Thus, while the neurological deficits of this model are mild, 109 and 106 both produced an improvement of motor coordination, whereas 109 and 136 produced increased locomotor activity. All three compounds increased global histone H3 and H4 acetylation of brain tissue, but only 109 significantly increased acetylation of specific histone residues at the FXN locus. Effects on FXN mRNA expression in CNS tissues were modest, but 109 significantly increased frataxin protein expression in brain tissue. 109 also produced significant increases in brain aconitase enzyme activity, together with reduction of neuronal pathology of the dorsal root ganglia (DRG). Overall, these results support further assessment of HDAC inhibitors for treatment of Friedreich ataxia.

This articles inquires about the consequences of social bots for the study and understanding of social media.

Friedreich's ataxia (FRDA), the most common recessive ataxia in Caucasians, is due to severely reduced levels of frataxin, a highly conserved protein, that result from a large GAA triplet repeat expansion within the first intron of the frataxin gene (FXN). Typical marks of heterochromatin are found near the expanded GAA repeat in FRDA patient cells and mouse models. Histone deacetylase inhibitors (HDACIs) with a pimelic diphenylamide structure and HDAC3 specificity can decondense the chromatin structure at the FXN gene and restore frataxin levels in cells from FRDA patients and in a GAA repeat based FRDA mouse model, KIKI, providing an appealing approach for FRDA therapeutics.In an effort to further improve the pharmacological profile of pimelic diphenylamide HDACIs as potential therapeutics for FRDA, we synthesized additional compounds with this basic structure and screened them for HDAC3 specificity. We characterized two of these compounds, 136 and 109, in FRDA patients' peripheral blood lymphocytes and in the KIKI mouse model. We tested their ability to upregulate frataxin at a range of concentrations in order to determine a minimal effective dose. We then determined in both systems the duration of effect of these drugs on frataxin mRNA and protein, and on total and local histone acetylation. The effects of these compounds exceeded the time of direct exposure in both systems.Our results support the pre-clinical development of a therapeutic approach based on pimelic diphenylamide HDACIs for FRDA and provide information for the design of future human trials of these drugs, suggesting an intermittent administration of the drug.

The James Brown song ‘I’m Real’ (1988) features lyrics regaled from James Brown’s back catalogue, alongside vocal samples extracted from his earlier hits. As one of the most sampled artists of the hip-hop era, James employed sampling in order to reclaim his position as the “Godfather of Soul” and express his disatisfaction at having his work overtly plundered. The central questions I pose here focus on what the choice to sample himself reveals about Brown’s status as a Soul legend, and whether the contemporaneous James could sincerely live up to the mythic status inherent to the message of ‘I’m Real’ given its self-conscious form. This confusion appears to be an extension of Walter Benjamin’s conception of déjà vu as an acoustic effect - ‘the cool tomb of long ago, from the vault of which the present seems to return only as an echo’ (Benjamin cited in Breyley, 2009: 145) - only here the slippage between past and present is quite literal, involving the discordant imbrication of two divergent temporal states. Via a detailed investigation of the song ‘I’m Real‘, I will probe Brown’s playful employment of his own past. His gambit, I will argue, may be read simultaneously as testament to his own glory, and as a signifier that the excesses of egotistic auto-projection were always more distant than they first appeared to be.