JURNAL AGROTEKNOLOGI
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What is "TCM"? A conservation-relevant taxonomy of traditional Chinese medicine
No full textThe global trade in wildlife affects ~24% of terrestrial vertebrates, and demand for traditional medicinal materials, especially for traditional Chinese medicine, is a high profile driver. Much research has established a causal link between demand for medicinal materials for "TCM" and negative impacts on species conservation and on individual animals’ welfare. Key hopes for reducing these impacts are demand reduction and redirection strategies, targetted at consumers and professionals. Conservation research papers routinely treat "TCM" as a homogenous entity, and we argue that in so doing fail to identify distinct markets or communities within "TCM", and that recognising these distinctions would facilitate strategies for demand reduction and redirection. We present an initial taxonomy of "TCM" - using medicinal materials derived from wild animal species as a proof of concept - separating it into three principal components: (a) zhongyi is the broad, all-inclusive medical field representing diverse medicinal materials used in so-called pre-modern and modern medical practice, and described in a number of traditional and revived modern texts; (b) TCM represents a regulated suite of medical and pharmaceutical practises that began to be established from zhongyi in the 1950s and also belongs among zhongyi practices today. Medicinal materials within TCM which represent a curated subset of those within wider zhongyi, are described in the Pharmacopoeia of the People’s Republic of China, and are subject to change (for example if trade in a species becomes strictly regulated); finally, (c) CMP, ‘Chinese medicine and pharmaco-therapy’ is a neo-liberal extension to mainly TCM but also to some aspects of zhongyi. It represents a highly commodified and commercialised form of TCM and zhongyi and includes also some newly designed health products not previously considered ‘traditional medical’ - let alone ‘traditional Chinese medical’ - which are dispensed in drug shops, frequently in the absence of a medical practitioner. Practitioners, suppliers and potentially consumers in each category of what in conservation circles is labelled using the blanket term "TCM" are likely to regard themselves as distinct from the others. This appreciation raises the possibility of working with official TCM authorities, professional bodies, academics and practitioners to reduce, and perhaps eliminate, the use of species of conservation and animal welfare concern
Arboreal categories and resources
No full textWe introduce arboreal categories, which have an intrinsic process structure, allowing dynamic notions
such as bisimulation and back-and-forth games, and resource notions such as number of rounds of
a game, to be defined. These are related to extensional or “static” structures via arboreal covers,
which are resource-indexed comonadic adjunctions. These ideas are developed in a very general,
axiomatic setting, and applied to relational structures, where the comonadic constructions for
pebbling, Ehrenfeucht-Fraïssé and modal bisimulation games recently introduced in [1, 5, 6] are
recovered, showing that many of the fundamental notions of finite model theory and descriptive
complexity arise from instances of arboreal covers
Energetic basis for exercise-induced pulmonary congestion in heart failure with preserved ejection fraction
No full textBackground:
Transient pulmonary congestion during exercise is emerging as an important determinant of reduced exercise capacity in heart failure with preserved ejection fraction (HFpEF). We sought to determine whether an abnormal cardiac energetic state underpins this process.
Methods:
We recruited patients across the spectrum of diastolic dysfunction and HFpEF (controls, n=11; type 2 diabetes, n=9; HFpEF, n=14; and severe diastolic dysfunction attributable to cardiac amyloidosis, n=9). Cardiac energetics were measured using phosphorus spectroscopy to define the myocardial phosphocreatine to ATP ratio. Cardiac function was assessed by cardiovascular magnetic resonance cine imaging and echocardiography and lung water using magnetic resonance proton density mapping. Studies were performed at rest and during submaximal exercise using a magnetic resonance imaging ergometer.
Results:
Paralleling the stepwise decline in diastolic function across the groups (E/e′ ratio; P<0.001) was an increase in NT-proBNP (N-terminal pro-brain natriuretic peptide; P<0.001) and a reduction in phosphocreatine/ATP ratio (control, 2.15 [2.09, 2.29]; type 2 diabetes, 1.71 [1.61, 1.91]; HFpEF, 1.66 [1.44, 1.89]; cardiac amyloidosis, 1.30 [1.16, 1.53]; P<0.001). During 20-W exercise, lower left ventricular diastolic filling rates (r=0.58; P<0.001), lower left ventricular diastolic reserve (r=0.55; P<0.001), left atrial dilatation (r=–0.52; P<0.001), lower right ventricular contractile reserve (right ventricular ejection fraction change, r=0.57; P<0.001), and right atrial dilation (r=–0.71; P<0.001) were all linked to lower phosphocreatine/ATP ratio. Along with these changes, pulmonary proton density mapping revealed transient pulmonary congestion in patients with HFpEF (+4.4% [0.5, 6.4]; P=0.002) and cardiac amyloidosis (+6.4% [3.3, 10.0]; P=0.004), which was not seen in healthy controls (–0.1% [–1.9, 2.1]; P=0.89) or type 2 diabetes without HFpEF (+0.8% [–1.7, 1.9]; P=0.82). The development of exercise-induced pulmonary congestion was associated with lower phosphocreatine/ATP ratio (r=–0.43; P=0.004).
Conclusions:
A gradient of myocardial energetic deficit exists across the spectrum of HFpEF. Even at low workload, this energetic deficit is related to markedly abnormal exercise responses in all 4 cardiac chambers, which is associated with detectable pulmonary congestion. The findings support an energetic basis for transient pulmonary congestion in HFpEF
Russian economic growth during the eighteenth century
No full textWe provide estimates of economic growth at decadal frequency for Russia during the eighteenth century. Although GDP per head increased between the 1690s and 1760s, this was followed by a period of negative growth between the 1760s and 1800s, leaving GDP per capita just 17 per cent higher at the end of the century than at its beginning. Although Russia’s strong growth in large-scale industry during the eighteenth century has received much attention, this was starting from a very low base. Peter the Great’s modernisation drive thus had only a small effect on the economy as a whole, which remained dominated by agriculture and small-scale industry
Introduction to the National Cancer Imaging Translational Accelerator (NCITA): a UK-wide infrastructure for multicentre clinical translation of cancer imaging biomarkers
No full textOptimising the flow through a concertinaed filtration membrane
No full textMembrane filtration is a vital industrial process, with applications
including air purification and blood filtration. In this paper, we study the
optimal design for a concertinaed filtration membrane composed of angled porous
membranes and dead-ends. We examine how the filter performance depends on the
angle, position, thickness, and permeance of the membrane, through a
combination of numerical and asymptotic approaches, the latter in the limit of
a slightly angled membrane. We find that, for a membrane of fixed angle and
physical properties, there can exist multiple membrane positions that maximise
the flux for an applied pressure difference. More generally, we show that while
the maximal flux achievable depends on the membrane thickness and permeance,
the optimal membrane configuration is always in one of two setups: centred and
diagonal across the full domain; or angled and in the corner of the domain
The data-driven future of high energy density physics
No full textHigh-energy-density physics is the field of physics concerned with studying matter at extremely high temperatures and densities. Such conditions produce highly nonlinear plasmas, in which several phenomena that can normally be treated independently of one another become strongly coupled. The study of these plasmas is important for our understanding of astrophysics, nuclear fusion and fundamental physics—however, the nonlinearities and strong couplings present in these extreme physical systems makes them very difficult to understand theoretically or to optimize experimentally. Here we argue that machine learning models and data-driven methods are in the process of reshaping our exploration of these extreme systems that have hitherto proved far too nonlinear for human researchers. From a fundamental perspective, our understanding can be improved by the way in which machine learning models can rapidly discover complex interactions in large datasets. From a practical point of view, the newest generation of extreme physics facilities can perform experiments multiple times a second (as opposed to approximately daily), thus moving away from human-based control towards automatic control based on real-time interpretation of diagnostic data and updates of the physics model. To make the most of these emerging opportunities, we suggest proposals for the community in terms of research design, training, best practice and support for synthetic diagnostics and data analysis
Experiences of preparing children for a death of an important adult during the COVID-19 pandemic: a mixed methods study
No full textOBJECTIVE: The objectives of this study were to investigate how families prepared children for the death of a significant adult, and how health and social care professionals provided psychosocial support to families about a relative's death during the COVID-19 pandemic. DESIGN/SETTING: A mixed methods design; an observational survey with health and social care professionals and relatives bereaved during the COVID-19 pandemic in the UK, and in-depth interviews with bereaved relatives and professionals were conducted. Data were analysed thematically. PARTICIPANTS: A total of 623 participants completed the survey and interviews were conducted with 19 bereaved relatives and 16 professionals. RESULTS: Many children were not prepared for a death of an important adult during the pandemic. Obstacles to preparing children included families' lack of understanding about their relative's declining health; parental belief that not telling children was protecting them from becoming upset; and parents' uncertainty about how best to prepare their children for the death. Only 10.2% (n=11) of relatives reported professionals asked them about their deceased relative's relationships with children. This contrasts with 68.5% (n=72) of professionals who reported that the healthcare team asked about patient's relationships with children. Professionals did not provide families with psychosocial support to facilitate preparation, and resources were less available or inappropriate for families during the pandemic. Three themes were identified: (1) obstacles to telling children a significant adult is going to die, (2) professionals' role in helping families to prepare children for the death of a significant adult during the pandemic, and (3) how families prepare children for the death of a significant adult. CONCLUSIONS: Professionals need to: provide clear and honest communication about a poor prognosis; start a conversation with families about the dying patient's significant relationships with children; and reassure families that telling children someone close to them is dying is beneficial for their longer term psychological adjustment
PRospective Evaluation of natriuretic peptide-based reFERral of patients with chronic heart failure in primary care (PREFER): a real-world study
No full textObjective To assess current management practice of heart failure with reduced ejection fraction (HFrEF) in multinational primary care (PC) and determine whether N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP)-guided referral of HFrEF patients from PC to a cardiologist could improve care, defined as adherence to European Society of Cardiology (ESC) guideline-recommended pharmacotherapy.
Methods PRospective Evaluation of natriuretic peptide-based reFERral of patients with chronic HF in PC (PREFER) study enrolled HFrEF patients from PC considered clinically stable and those with NT-pro-BNP ≥600 pg/mL were referred to a cardiologist for optimisation of HF treatment. The primary outcome of adherence to ESC HF guidelines after referral to specialist was assessed at the second visit within 4 weeks of cardiologist’s referral and no later than 6 months after the baseline visit. Based on futility interim analysis, the study was terminated early.
Results In total, 1415 HFrEF patients from 223 PCs from 18 countries in Europe were enrolled. Of these, 1324 (96.9%) were considered clinically stable and 920 (65.0%) had NT-pro-BNP ≥600 pg/mL (mean: 2631 pg/mL). In total, 861 (60.8%) patients fulfilled both criteria and were referred to a cardiologist. Before cardiologist consultation, 10.1% of patients were on ESC guideline-recommended HFrEF medications and 2.7% were on recommended dosages of HFrEF medication (defined as ≥50% of ESC guideline-recommended dose). Postreferral, prescribed HFrEF drugs remained largely unchanged except for an increase in diuretics (+4.6%) and mineralocorticoid receptor antagonists (+7.9%). No significant increase in patients’ adherence to guideline-defined drug combinations (11.2% post-referral vs 10.1% baseline) or drug combinations and dosages (3.3% postreferral vs 2.7% baseline) was observed after cardiologist consultation.
Conclusions PREFER demonstrates substantial suboptimal treatment of HFrEF patients in the real world. Referral of patients with elevated NT-pro-BNP levels from PC to cardiologist did not result in meaningful treatment optimisation for treatments with known mortality and morbidity benefit
Thermal equilibrium of an ideal gas in a free-floating box
No full textThe equilibrium and fluctuations of an ideal gas in a rigid container are studied by every student of statistical mechanics. Here, we examine the less well-known case when the box is floating freely; in particular, we determine the fluctuations of the box in velocity and position due to interactions with the gas it contains. This system is a toy model for the fluctuations in velocity and position of a black hole surrounded by stars at the center of a galaxy. These fluctuations may be observable in nearby galaxies