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Get plants : how to bring green into your life
Plants are amazing. They remind you of deserts and mountains and forests, bring nature to your home and make you feel better. Who wouldn't choose to share a space with them-- but where do you start? The good news is there's a plant for every windowsill, door step or shady yard. Whatever your style -- from urban sleek to shabby chic to retro -- there are plants that will fit into your life and make it brighter. This book shows you how, by drawing on the work of the Royal Botanic Gardens, Kew -- its science, fieldwork, collections and horticultural knowledge. Katherine Price weaves the advice of gardeners and scientists, distilling the essence of Kew's expertise into an engaging practical guide. This no-nonsense, beautiful book is guaranteed to inspire everyone. -- Back cover.
Book
Control and prediction of the organic solid state: a challenge to theory and experiment
The ability of theoretical chemists to quantitatively model the weak forces between organic molecules is being exploited to predict their crystal structures and estimate their physical properties. Evolving crystal structure prediction methods are increasingly being used to aid the design of organic functional materials and provide information about thermodynamically plausible polymorphs of speciality organic materials to aid, for example, pharmaceutical development. However, the increasingly sophisticated experimental studies for detecting the range of organic solid-state behaviours provide many challenges for improving quantitative theories that form the basis for the computer modelling. It is challenging to calculate the relative thermodynamic stability of different organic crystal structures, let alone understand the kinetic effects that determine which polymorphs can be observed and are practically important. However, collaborations between experiment and theory are reaching the stage of devising experiments to target the first crystallization of new polymorphs or create novel organic molecular materials.
Journal Article
Open-Source Automated Insulin Delivery in Type 1 Diabetes
Open-source automated insulin delivery (AID) systems are used by many patients with type 1 diabetes. Data are needed on the efficacy and safety of an open-source AID system.
In this multicenter, open-label, randomized, controlled trial, we assigned patients with type 1 diabetes in a 1:1 ratio to use an open-source AID system or a sensor-augmented insulin pump (control). The patients included both children (defined as 7 to 15 years of age) and adults (defined as 16 to 70 years of age). The AID system was a modified version of AndroidAPS 2.8 (with a standard OpenAPS 0.7.0 algorithm) paired with a preproduction DANA-i insulin pump and Dexcom G6 CGM, which has an Android smartphone application as the user interface. The primary outcome was the percentage of time in the target glucose range of 70 to 180 mg per deciliter (3.9 to 10.0 mmol per liter) between days 155 and 168 (the final 2 weeks of the trial).
A total of 97 patients (48 children and 49 adults) underwent randomization (44 to open-source AID and 53 to the control group). At 24 weeks, the mean (±SD) time in the target range increased from 61.2±12.3% to 71.2±12.1% in the AID group and decreased from 57.7±14.3% to 54.5±16.0% in the control group (adjusted difference, 14 percentage points; 95% confidence interval, 9.2 to 18.8; P<0.001), with no treatment effect according to age (P = 0.56). Patients in the AID group spent 3 hours 21 minutes more in the target range per day than those in the control group. No severe hypoglycemia or diabetic ketoacidosis occurred in either group. Two patients in the AID group withdrew from the trial owing to connectivity issues.
In children and adults with type 1 diabetes, the use of an open-source AID system resulted in a significantly higher percentage of time in the target glucose range than the use of a sensor-augmented insulin pump at 24 weeks. (Supported by the Health Research Council of New Zealand; Australian New Zealand Clinical Trials Registry number, ACTRN12620000034932.).
Journal Article
Considering the use of GLP-1 receptor agonists in women with obesity prior to pregnancy: a narrative review
Purpose
Metabolic disease, including obesity and type 2 diabetes, are amongst the most significant health issues facing women of reproductive age. To date, no antenatal weight management tools have reduced the risk of adverse health outcomes for women with obesity and their offspring, resulting in a shift in focus to the pre-conception period. Although not yet recognised in most international weight management guidelines, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are being increasingly used for weight management prior to conception.
Methods
A literature search of PubMed, Medline, and Embase databases identified relevant articles describing the use of GLP-1 RAs prior to and during pregnancy. Papers were selected based on relevance and originality, with clinical trials, large observational studies and meta-analyses being preferentially included.
Results
This narrative review summarises the mechanism of action of GLP-1 RAs and the clinical effects observed in non-pregnant adults. It synthesises the available data from human and animal studies regarding the safety and efficacy of GLP-1 RAs prior to pregnancy, and the consequences of inadvertent drug exposure in early pregnancy. In considering the need to balance the risks of metabolic disease with the risks posed by inadvertent drug exposure, it highlights the areas where further research is needed to guide clinical decision-making.
Conclusion
GLP-1 RAs may have a role in facilitating weight loss and improving the metabolic health of women prior to pregnancy. However, there is currently insufficient evidence to demonstrate that the use of this class of drugs prior to pregnancy improves pregnancy outcomes.
Journal Article
WHAM—A Prospective Study of Weight and Body Composition After Risk-Reducing Bilateral Salpingo-oophorectomy
Abstract
Context
Body weight and composition may change over the natural menopause transition. Whether surgical menopause has similar effects, and the impact of hormone replacement therapy (HRT), are unknown. Understanding the metabolic effects of surgical menopause will inform clinical care.
Objective
To prospectively measure weight and body composition over 24 months following surgical menopause compared with a similar comparison group who retained their ovaries.
Methods
Prospective observational study of weight change from baseline to 24 months in 95 premenopausal women at elevated risk of ovarian cancer planning risk-reducing salpingo-oophorectomy (RRSO) and 99 comparators who retained their ovaries. Change in body composition from baseline to 24 months was also assessed by dual-energy x-ray absorptiometry in a subgroup of 54 women who underwent RRSO and 81 comparators who retained their ovaries. In the subgroup, weight, fat mass, lean mass, and abdominal fat measures were compared between groups.
Results
At 24 months both groups had gained weight (RRSO 2760 ± 4860 g vs comparators 1620 ± 4540 g) with no difference between groups (mean difference 730 g; 95% CI 920 g to 2380 g; P = .383). In the body composition subgroup, there was no difference in weight between groups at 24 months (mean difference 944 g; 95% CI −1120 g to 2614 g; P = .431). RRSO women may have gained slightly more abdominal visceral adipose tissue (mean difference 99.0 g; 95% CI 8.8 g to 189.2 g; P = .032) but there were no other differences in body composition. There were also no differences in weight or body composition between HRT users and nonusers at 24 months.
Conclusion
24 months after RRSO, there was no difference in body weight compared with women who retained their ovaries. RRSO women gained more abdominal visceral adipose tissue than comparators, but there were no other differences in body composition. Use of HRT following RRSO had no effect on these outcomes.
Journal Article
The impact of changing risk thresholds on the number of people in England eligible for urgent investigation for possible cancer: an observational cross-sectional study
Background
Expediting cancer diagnosis may be achieved by targeted decreases in referral thresholds to increase numbers of patients referred for urgent investigation.
Methods
Clinical Practice Research Datalink data from England for 150,921 adults aged ≥40 were used to identify participants with features of possible cancer equating to risk thresholds ≥1%, ≥2% or ≥3% for breast, lung, colorectal, oesophago-gastric, pancreatic, renal, bladder, prostatic, ovarian, endometrial and laryngeal cancers.
Results
The mean age of participants was 60 (SD 13) years, with 73,643 males (49%). In 2016, 8576 consultation records contained coded features having a positive predictive value (PPV) of ≥3% for any of the 11 cancers. This equates to a rate of 5682/100,000 patients compared with 4601/100,000 Suspected Cancer NHS referrals for these cancers from April 2016–March 2017. Nine thousands two hundred ninety-one patient-consultation records had coded features equating to a ≥2% PPV, 8% more than met PPV ≥ 3%. Similarly, 19,517 had features with a PPV ≥ 1%, 136% higher than for PPV ≥ 3%.
Conclusions
This study estimated the number of primary-care patients presenting at lower thresholds of cancer risk. The resource implications of liberalising this threshold to 2% are modest and manageable. The details across individual cancer sites should assist planning of English cancer services.
Journal Article
Folate Supplementation in Women with Pre-Existing Diabetes
Folate supplementation in the periconceptual period is the standard of care for the prevention of neural tube defects. To support dietary folate intake, some countries have introduced mandatory folic acid fortification of food products. Robust evidence supports the additional use of a low-dose folic acid supplement (0.4 mg/day) in all women from 2–3 months preconception until the end of the 12th week of gestation. For women with pre-existing diabetes, high-dose folic acid supplementation (5 mg/day) is recommended in some, but not all international guidelines. The recommendation is made based on consensus opinion and reflects the increased risk of neural tube defects in pregnant women with pre-existing diabetes. However, there is limited evidence to clarify the high-risk groups that benefit from high-dose folic acid versus those that do not. There are also some data to suggest that high-dose folic acid may be harmful to mothers and offspring, although this issue remains controversial. This narrative review explores the evidence that supports the recommendation for women with pre-existing diabetes to take high-dose folic acid in the periconceptual period. It explores the potential benefits of high-dose supplemental folate beyond the prevention of neural tube defects, and also the potential adverse impacts of high-dose folate use. These topics are considered with a specific focus on the issues that are pertinent to women with pre-existing diabetes. Based on the available evidence, a pragmatic approach to the use of folic acid supplements in women with pre-existing diabetes during the periconception period is suggested. The need for comprehensive preconception care that optimises glycaemic control and addresses other modifiable risk factors before pregnancy is emphasized.
Journal Article
A large exploratory survey of electroconvulsive therapy recipients, family members and friends: what information do they recall being given?
The right to informed consent is a core ethical principle. Recent audits of patient information leaflets about electroconvulsive therapy (ECT), in Australia, England, Northern Ireland, Scotland and Wales, suggest that this principle is often not implemented, with efficacy being exaggerated and risks minimised. In the current study a convenience sample of 858 ECT recipients and 286 family members and friends, from 44 countries, responded to an online survey about their experiences of ECT, including the information they recall being given to them before ECT. Most (59%) of the ECT recipients reported that they had not been given ‘adequate information’ and a further 17% were ‘not sure’. For example, 63% of recipients recall being told that ‘ECT can cause temporary memory problems’, but only 17% that ‘ECT can cause long-term or permanent memory problems, 12% that ‘ECT can cause heart problems’ and 28% that there are ‘Risks from repeated general anaesthesia’. There were higher levels of recalling being told about definite benefits, even though some of these benefits are disputed. When asked to consider a list of items of misinformation, many recipients and relatives reported being told ‘Depression is caused by a chemical imbalance in the brain’ (58% and 53%, respectively) and ‘ECT corrects chemical imbalance or other brain abnormality’ (42% and 41%). Study limitations include potential sampling issues (eg, self-selection bias, snowball sampling bias, or other barriers to representativeness due to convenience sampling or network-based recruitment), as well as potential recall bias among survey respondents (last ECT treatment was between 1958 and 2024; average=2012.5). Nevertheless, these findings, in conjunction with previous studies, suggest an urgent need for greater efforts to ensure that patients and families are provided with comprehensive, balanced, evidence-based information when deciding whether to have ECT.
Journal Article
Bodies of Knowledge: Biomarkers and Rhetoric of the Body
This manuscript offers a critical rhetorical analysis of a multi-site, longitudinal study’s procedures in collecting and recording biomarkers. This manuscript opens new areas of exploration for the field of the rhetoric of health and medicine as the biomarker sampling for measures of stress, and resilience tie to critical rhetorical theories surrounding power and the body. The training manuals and protocols disseminated to the multi-site research team serve as rhetorical artifacts to examine questions of how the choices of biomarkers and the procedures employed to collect the samples needed to measure them are in and of themselves a production of health knowledge of the bodies and identities of transgender and gender diverse people. This manuscript presents an investigation of the processes of biomarker sample collection in conjunction with how the biomarkers are conceptualized as a means of deconstructing hegemonic assertions of gender and health normality.
Journal Article