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Recognition, explanation, action, learning: teaching and delivery of a consultation model for persistent physical symptoms
Get PDFThis article consists of a citation of a published article describing research funded by the Health and Social Care Delivery Research programme under project number 15/136/07, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1016/j.pec.2023.107870
Objective
To describe the teaching and delivery of an extended consultation model designed for clinicians to use with patients with persistent physical symptoms and functional disorders. The model is underpinned by current scientific knowledge about persistent physical symptoms and the communication problems that arise in dealing with them.
Methods
Process evaluation of training and delivery of the Recognition, Explanation, Action, Learning (REAL) model within the Multiple Symptoms Study 3: a randomised controlled trial of an extended-role GP “Symptoms Clinic”. Evaluation used clinician and patient interviews and consultation transcripts.
Results
7 GPs were trained in the intervention and 6 of them went on to deliver the REAL model in Symptoms Clinics either face-to-face or online. The Symptoms Clinic provided a set of 4 extended consultations to approximately 170 patients. Evaluation of training indicated that there was a considerable load in terms of new knowledge and skills. Evaluation of delivery found clinicians could adapt the model to individual patients while maintaining a high level of fidelity to its core components.
Conclusion
REAL is a teachable consultation model addressing specific clinical communication issues for people with persistent physical symptoms.
Practice implications
REAL enables clinicians to explain persistent physical symptoms in a beneficial way.
Funding
This publication was funded by the Health and Social Care Delivery Research programme as a part of award number 15/136/07
Turn up the red: MADS-RIN-DIVARICATA1 module positively regulates carotenoid biosynthesis in nonclimacteric pepper fruits
Get PDFPeppers are used worldwide for their nutritional value, unique taste, and vibrant colors. Unripe pepper fruits display shades such as white, purple, or green, transitioning to carotenoid-based colors—yellow, orange, and red—as they ripen. Carotenoids, lipid-soluble molecules essential for photosynthesis and photoprotection, are synthesized through well-characterized enzymes (Rodriguez-Uribe et al. 2012; Gómez-García and Ochoa-Alejo 2013), including phytoene synthase 1 (PSY1) and capsanthin/capsorubin synthase (CCS) (Fig.). The transcriptional network promoting carotenoid synthesis, among other traits, during ripening is partially elucidated in tomato, a model species for fruit ripening. However, as a nonclimacteric fruit, pepper relies on potentially different and less-understood regulatory mechanisms for carotenoid biosynthesis. Recently, the MYELOBLASTOSIS (MYB) containing two repeats (R2R3-MYB) transcription factor DIVARICATA1 was shown to be a positive regulator of capsanthin content through direct activation of PSY1 and CCS transcription (Song et al. 2023). Interestingly, the well-studied ripening regulator, MADS box transcription factor RIPENING INHIBITOR (MADS-RIN), key in triggering climacteric ripening, is coexpressed with DIVARICATA1 and activates its promoter in pepper. These findings open the question of whether these 2 transcription factors interact to modulate carotenoid biosynthesis (Song et al. 2023)
Large-baseline quantum telescopes assisted by partially distinguishable photons
Get PDFQuantum entanglement can be used to extend the baseline of telescope arrays in order to increase the spatial resolution. In one proposal by Marchese and Kok [Phys. Rev. Lett. 130, 160801 (2023)], identical single photons are shared between receivers and interfere with a star photon. In this paper we consider two outstanding questions: (i) what is the precise effect of the low photon occupancy of the mode associated with the starlight? and (ii) what is the effect on the achievable resolution of imperfect indistinguishability (or partial distinguishability) between the ground and star photons? We find that the effect of distinguishability is relatively mild, but low photon occupancy of the optical mode of the starlight quickly deteriorates the sensitivity of the telescope for higher auxiliary photon numbers
RingSim—an agent-based approach for modeling mesoscopic magnetic nanowire networks
Get PDFWe describe “RingSim,” a phenomenological agent-based model that allows numerical simulation of magnetic nanowire networks with areas of hundreds of micrometers squared for durations of hundreds of seconds, a practical impossibility for general-purpose micromagnetic simulation tools. In RingSim, domain walls (DWs) are instanced as mobile agents, which respond to external magnetic fields, and their stochastic interactions with pinning sites and other DWs are described via simple phenomenological rules. We first present a detailed description of the model and its algorithmic implementation for simulating the behaviors of arrays of interconnected ring-shaped nanowires, which have previously been proposed as hardware platforms for unconventional computing applications. The model is then validated against a series of experimental measurements of an array’s static and dynamic responses to rotating magnetic fields. The robust agreement between the modeled and experimental data demonstrates that agent-based modeling is a powerful tool for exploring mesoscale magnetic devices, enabling time scales and device sizes that are inaccessible to more conventional magnetic simulation techniques
An atomically resolved study of droplet epitaxy InAs quantum dots grown on InGa(As,P)/InP by MOVPE for quantum photonic applications
Get PDFWe investigated droplet epitaxy InAs/InP quantum dots (QDs) grown by MOVPE on two different substrate interlayers of InGaAs and InGaAsP, both lattice-matched to InP, by cross-sectional scanning tunneling microscopy (X-STM) and AFM (atomic force microscopy). We compared, at the atomic scale, the structural and compositional properties of the QDs grown on the two different surfaces. On both interlayers, the QDs present a truncated pyramid shape with a rhomboid base, flat top and bottom facets, and side planes corresponding to {136} planes. Finite element simulations (FESs) are performed to fit the experimental outward relaxation of the QDs and the lattice constant profiles. The X-STM results and FES confirm that the QDs grown on InGaAsP present a composition with less than 5% P intermixing, whereas the QDs on InGaAs have a slightly higher P incorporation but still less than 10% of P intermixing. This study confirms that both interlayers suppress the etching mechanisms, previously identified as etch pits and trenches, when growing InAs QDs directly on InP. The InGaAs and InGaAsP interlayers both show lateral composition modulation, with much stronger fluctuations and filamentation displayed in the InGaAsP interlayer. We demonstrate that the growth on InGaAsP produces InAs QDs with a high crystal quality comparable to those grown on InP and control over the etching mechanisms. The detailed study performed in this work shows the successful integration of high-quality InAs/InP QDs with the InGaAsP surface, which is used in many applications in a wide range of photonic devices and quantum technologies
Empirical assessment of functional somatic disorder (FSD): frequency, applicability, and diagnostic refinement in a population-based sample
Get PDFBackground
Persistent and troublesome physical symptoms are common and can, regardless of their cause, greatly impair patients’ quality of life. Reflecting complex brain-body interactions, they are observed across all healthcare specialties, commonly overlap across them, and receive inconsistent diagnoses. In response, the international research network EURONET-SOMA has proposed a diagnostic classification for persistent and troublesome symptoms entitled “functional somatic disorder (FSD)”. Focusing on symptom patterns across organ systems, the FSD approach aims to enhance diagnosis, treatment, and healthcare access for patients. However, further research is needed to validate its effectiveness and clinical utility. This study assessed the frequency and applicability of the FSD proposal within a population-based sample.
Methods
FSD diagnostic criteria were cross-sectionally operationalised within the multi-disciplinary prospective cohort study Lifelines, conducted in the Dutch population. Kruskal–Wallis and chi-square tests with effect size estimates were used to investigate differences in the diagnostic subgroups regarding chronic diseases, functional comorbidities and psycho-behavioural features. Binary logistic regression with elastic net penalisation was used to investigate sociodemographic, psycho-behavioural and clinical factors associated with FSD.
Results
Of the study population (N = 88,925), 58% met the diagnostic criteria for FSD. Of those meeting FSD, 31% reported a single distressing symptom, 18% had several symptoms attributable to one organ system and 52% reported multiple symptoms from various organ systems. Moderate differences between these subgroups were found for health status, neuroticism, long-term life difficulties and healthcare utilisation. Elastic net regression showed comorbid chronic musculoskeletal (OR 1.8), gastrointestinal disease (OR 1.4), neurological disease (OR 1.2), and female sex (OR 1.2) predicted FSD. Concurrent anxiety (OR 1.6), healthcare visits (OR 1.3) and long-term difficulties (OR 1.2) were associated with the presence of FSD.
Conclusions
This study supports refining the FSD criteria to avoid over-inclusiveness. Current symptom severity and frequency thresholds need adjustment to better identify those needing treatment. The distinction between single and multiple symptom categories is important, and optional specifiers like comorbid chronic diagnoses and psychological factors seem valuable for predicting FSD. Despite warranting further research, the FSD classification is promising for diagnosing persistent and troublesome symptoms across medical specialties
Mating strategy does not affect the diversification of abdominal chemicals in Heliconiini butterflies
Get PDFAntiaphrodisiacs are chemical bouquets physically delivered from male to female individuals upon copulation which discourage further mating and reduce sperm competition by rendering the female less attractive. Since antiaphrodisiacs may not offer an honest signal of female receptivity, in polyandrous species they may undergo faster diversification resulting from sexual conflict. The Heliconiini tribe of butterflies includes a polyandrous (free-mating) and a monandrous (pupal-mating) clade, both known to produce diverse antiaphrodisiac mixtures as part of their abdominal blends. Using multivariate phylogenetic comparative methods, we analyzed the genital blends of 36 Heliconiini species to test the hypothesis that blend diversity results from male-male competition in polyandry. We found no evidence for shifts in blend diversification rate corresponding to changes in mating strategy, implying male-male competition may have a weaker effect on pheromone diversification in this group than previously thought. The genital blends of most species are dominated by one of four highly volatile compounds; (E)-β-ocimene, octen-3-one, sulcatone and 4-hydroxycyclopent-2-en-1-one. Based on the function of (E)-β-ocimene as the behaviourally active antiaphrodisiac in H. melpomene, we propose a similar role in other species for the other volatiles. We test this hypothesis by investigating 4-hydroxycyclopent-2-en-1-one occurrence in Heliconius sara. While we detect no sex-based differences on its presence, we find the compound is undetectable when larvae are not fed their preferred host plant, providing an intriguing potential link between host plant and reproductive cues. This in turn shows that captive-bred samples do not always provide realistic results and this awareness is important for future experiments
Disentangling nonrandom structure from random placement when estimating β-diversity through space or time
Get PDFThere is considerable interest in understanding patterns of β-diversity that measure the amount of change in species composition through space or time. Most hypotheses for β-diversity evoke nonrandom processes that generate spatial and temporal within-species aggregation; however, β-diversity can also be driven by random sampling processes. Here, we describe a framework based on rarefaction curves that quantifies the nonrandom contribution of species compositional differences across samples to β-diversity. We isolate the effect of within-species spatial or temporal aggregation on beta-diversity using a coverage standardized metric of β-diversity (βC). We demonstrate the utility of our framework using simulations and an empirical case study examining variation in avian species composition through space and time in engineered versus natural riparian areas. The primary strengths of our approach are that it provides an intuitive visual null model for expected patterns of biodiversity under random sampling that allows integrating analyses across α-, γ-, and β-scales. Importantly, the method can accommodate comparisons between communities with different species pool sizes, and it can be used to examine species turnover both within and between meta-communities
Antimicrobial Resistance (AMR) Development Map:A Conceptual Map and a Tool to Support Economic Evaluation of AMR Interventions
Get PDFINTRODUCTION: Antimicrobial resistance (AMR) is a complex, inter-sectoral and international problem. Economic evaluation (EE) methods offer systematic, evidence-driven approaches to inform policy decisions about which AMR interventions to fund. EE of AMR interventions is complicated owing to diffuse effects, complex mechanics of the problem and high levels of uncertainty. Current AMR EE literature restricts the analytical scope, potentially resulting in omissions of effects that may limit the utility of EE to inform policy decisions. We aimed to systemise the key evolutionary and ecological processes of AMR to elucidate the paths through which AMR interventions impact population health and healthcare costs to support EE design and to support decision makers in understanding the limitations of EE evidence for decision-making. METHODS: A conceptual map and a corresponding tool were developed on the basis of a literature review in consultation with experts across the relevant disciplines of molecular biology, infectious disease modelling, health economics and ecology. RESULTS: The AMR development map: (1) distils the key AMR processes and process drivers behind AMR development and maps the available types of AMR interventions to AMR process drivers; (2) proposes a way to conceptualise the spatial scope of analysis through considering the connectivity of the wider ecosystem and (3) outlines the key dimensions that AMR burden and intervention effects could be measured across. An AMR development map tool was developed to support conceptual modelling, with the focus on the choice of scope in the EE of AMR interventions, and an illustrative case study was provided. DISCUSSION: This work summarises the key underlying biological principles of AMR development to provide mechanistical grounding for considering the scope of effects of AMR interventions and the appropriate system of analysis to support conceptual modelling in EE of AMR interventions. In addition, this map can facilitate the identification of effects that cannot be considered or quantified, thus enabling transparency about these omissions within decision-making
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