Explore the vast range of titles available.

We have developed multi-channel electronics (MCE) which work in concert with time-domain multiplexors developed at NIST, to control and read signals from large format bolometer arrays of superconducting transition edge sensors (TESs). These electronics were developed as part of the Submillimeter Common-User Bolometer Array-2 (SCUBA2 ) camera, but are now used in several other instruments. The main advantages of these electronics compared to earlier versions is that they are multi-channel, fully programmable, suited for remote operations and provide a clean geometry, with no electrical cabling outside of the Faraday cage formed by the cryostat and the electronics chassis. The MCE is used to determine the optimal operating points for the TES and the superconducting quantum interference device (SQUID) amplifiers autonomously. During observation, the MCE execute a running PID-servo and apply to each first stage SQUID a feedback signal necessary to keep the system in a linear regime at optimal gain. The feedback and error signals from a ∼1000-pixel array can be written to hard drive at up to 2 kHz.

Abstract Objective To provide perinatal mortality and congenital anomaly rates for babies born to women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland. Design National population based pregnancy cohort. Setting 231 maternity units in England, Wales, and Northern Ireland. Participants 2359 pregnancies to women with type 1 or type 2 diabetes who delivered between 1 March 2002 and 28 February 2003. Main outcome measures Stillbirth rates; perinatal and neonatal mortality; prevalence of congenital anomalies. Results Of 2359 women with diabetes, 652 had type 2 diabetes and 1707 had type 1 diabetes. Women with type 2 diabetes were more likely to come from a Black, Asian, or other ethnic minority group (type 2, 48.8%; type 1, 9.1%) and from a deprived area (type 2, 46.3% in most deprived fifth; type 1, 22.8%). Perinatal mortality in babies of women with diabetes was 31.8/1000 births. Perinatal mortality was comparable in babies of women with type 1 (31.7/1000 births) and type 2 diabetes (32.3/1000) and was nearly four times higher than that in the general maternity population. 141 major congenital anomalies were confirmed in 109 offspring. The prevalence of major congenital anomaly was 46/1000 births in women with diabetes (48/1000 births for type 1 diabetes; 43/1000 for type 2 diabetes), more than double that expected. This increase was driven by anomalies of the nervous system, notably neural tube defects (4.2-fold), and congenital heart disease (3.4-fold). Anomalies in 71/109 (65%) offspring were diagnosed antenatally. Congenital heart disease was diagnosed antenatally in 23/42 (54.8%) offspring; anomalies other than congenital heart disease were diagnosed antenatally in 48/67 (71.6%) offspring. Conclusion Perinatal mortality and prevalence of congenital anomalies are high in the babies of women with type 1 or type 2 diabetes. The rates do not seem to differ between the two types of diabetes.

SCUBA-2 is a state of the art 10,000 pixel submillimeter camera providing wide-field simultaneous imaging at 450 and 850 microns. The instrument is in the final stages of commissioning at the JCMT and is the largest low temperature detector array in operation. Twin focal planes each consist of four 32 by 40 sub-arrays of superconducting Transition Edge Sensor (TES) bolometers, with inline SQUID time-division multiplexed readout. In this paper we discuss the challenges and steps taken to optimise the performance of the SCUBA-2 arrays and maximise the mapping speed of the instrument. We present results of characterising the eight 1280 bolometer arrays and show the performance of the detectors and the instrument.

Abstract Introduction: Fatigue is one of the most debilitating symptoms of multiple sclerosis (MS), and is present in up to 80% of persons with MS (pwMS). It has also more recently been realized that sleep disorders, including insomnia, are highly prevalent in pwMS. Insomnia is often associated with daytime impairments, such as fatigue, however, few studies have examined the extent to which insomnia is related to fatigue in this population. Thus, this study aimed to examine the relationship between insomnia symptom severity and fatigue in pwMS. Methods: Preliminary analyses were conducted to examine 13 participants with relapsing-remitting MS (RRMS) who completed a demographic questionnaire, the Insomnia Severity Inventory (ISI), the Fatigue Severity Scale (FSS), and the Beck Depression Inventory Fast Screen (BDI-FS). Participants were excluded if they had experienced an exacerbation of symptoms or change in medical regimen within 30 days of participation. A multiple regression analysis, with ISI and BDI-FS as predictor variables and FSS as outcome variable, was utilized to assess the relationships between insomnia symptom severity, depression, and fatigue. Results: Participants (M age = 45.6, SD = 6.4) were primarily women (n = 9). ISI scores ranged from 2 - 26, with 30.7% endorsing no significant insomnia, 38% endorsing subthreshold insomnia, and 30.7% endorsing clinically significant insomnia (moderate and severe). ISI scores were significantly associated with FSS scores, after adjusting for BDI-FS scores, b=1.50, SEb=.40, 95% CIb [.61, 2.40], p < .01. The overall model explained 62% of the variance seen in FSS scores (R2 = .62). Conclusion: Insomnia symptom severity is related to severity of fatigue in those with RRMS. Thus, the treatment of insomnia may lead to significant improvements in fatigue in pwMS. Support (If Any):

While the article by Brendan Docherty ‘12-lead ECG interpretation and chest pain management: 1’ (Vol 12(21): 1248–55) is a useful introduction to this area of practice there are a number of inaccuracies and areas of confusion.

ObjectivesWe compare data collected by England's National Chlamydia Screening Programme (NCSP) with national probability survey data to examine demographic and behavioural differences that may be important in understanding who the NCSP is reaching and interpreting chlamydia positivity.MethodsData for 538 119 men and women aged 16–24 years who were screened in 2008 and data collected from 2180 interviewees in Britain's second National Survey of Sexual Attitudes and Lifestyles 1999–2001 (Natsal-2), of whom 644 were tested for chlamydia, were compared using the χ2 statistic and logistic regression.ResultsCompared with Natsal-2, the NCSP tested more women (67% vs 49%). NCSP participants were more likely to be younger: 29% were 16–17 years versus 16% of men and 15% of women in Natsal-2; from ethnic minority groups: 17% of men and 14% of women versus 8% and 6%, respectively, in Natsal-2; not to have used condoms at last sex: 66% of men and 68% of women versus 48% and 63%, respectively, in Natsal-2: and more likely to report two or more partners in the last year: 62% of men and 47% of women versus 47% and 30%, respectively, in Natsal-2. In multivariate analyses, higher AOR of chlamydia positivity were found for those reporting non-use of condoms and for those reporting multiple partners in both the NCSP and Natsal-2.ConclusionsThe NCSP is testing young people at increased risk of chlamydia. The impact of this testing bias on the effectiveness of the programme should be evaluated.

The many responsibilities of primary care, cardiac rehabilitation and secondary prevention of coronary heart disease is a growing concern. Demanding standards have been given to primary care in the National Service Framework for Coronary Heart Disease. This article reports an evaluation of an intervention to support primary care service providers in this responsibility. A part-time specialist nurse and a part-time exercise worker were appointed to work in a group of 11 GP practices in a primary care trust in a city in the north of England. The evaluation component reported here is a qualitative study of the perceptions of health professionals on secondary prevention of coronary heart disease. Interviews were conducted with 18 primary care staff from practices in both intervention (n=11) and control (n=11) groups. The evaluation revealed support for the development of nurse-led clinics, increased confidence and skills development among practice nurses, but some concern about competing demands on practice nurses' time. Primary healthcare professionals found their resources stretched by competing demands on their time from government initiatives.

Background: The purpose of this study was to examine variation in positivity within the English National Chlamydia Screening Programme during 2007/2008. Methods: Data were analyzed using multivariable logistic regression. The outcome measure was positivity. Funnel plots were used to explore variation in positivity according to screening volume. Results: Three hundred and thirty-four thousand nine hundred and two screening tests were done, 29% of which were in men. Overall positivity was 7.6% in men and 9.3% in women. For men, positivity increased rapidly to plateau from ages 19 to 24. For women, rates peaked at 18 years—those aged 21 being at the same risk of chlamydial infection as 16-year-olds. For men and women, positivity was generally higher for those of black or mixed ethnicity compared with whites, whereas Asians were at lower risk. Similarly, risk of infection for men and women varied by screening venue. Multivariable analysis showed that, for men and women positivity varied significantly with age, ethnicity, screening venue attended, whether the young people had had a new sexual partner in the past 3 months, and whether the patient had had 2 or more sexual partners in the past year. Positivity did not vary significantly with implementation phase. Conclusions: This is the largest description of testing for Chlamydia trachomatis in healthcare and nonhealthcare settings outside Genitourinary Medicine clinics in England and allowed a detailed analysis of positivity by age and ethnic group. Considerable heterogeneity exists and local health service commissioners need to ensure that the implementation of chlamydial screening reflects these differences.

BackgroundThe ESCAPE trial was a multicentre randomised controlled trial investigating the effectiveness of Chest Pain Unit (CPU) care. The process of CPU implementation and the activity of individual CPUs varied substantially between hospitals. The study reported here explored the organisational factors that influenced this variation.MethodA multiple case study approach was taken treating each site as a ‘case’. Six intervention sites were studied. Qualitative data were collected through interviews with key personnel at each site.ResultsActivity of individual CPUs was not adequately explained by simple structural differences between hospitals, such as their size or location, or between CPUs, such as staffing and hours. Analysis suggested that the more active CPUs tended to have more of the following characteristics: being ‘primed’ by previous initiative or experience; appropriate leadership; a positive climate for innovation; established relationships between key staff/departments; role clarity amongst staff; an enthusiast for the development; and continuity of staffing. Role conflict, particularly between specialist nurses and others, was reported and had potential to interfere with development.ConclusionOrganisational factors were identified that could have impacted on the outcomes of the ESCAPE trial through, for example, delays in discharge, and missed recruitment opportunities. Complex interventions such as the ESCAPE trial are prone to the effects of local organisational issues, some of which could be predicted and planned for. Findings from single centre studies of complex interventions should be treated with caution before a decision is taken to implement in a new setting.